Etienne Puymirat1, Nadia Aissaoui2, Guillaume Cayla3, Alexandre Lafont4, Elisabeth Riant4, Marco Mennuni5, Olivier Saint-Jean6, Didier Blanchard7, Patrick Jourdain8, Meyer Elbaz9, Patrick Henry10, Vincent Bataille11, Elodie Drouet12, Geneviève Mulak13, François Schiele14, Jean Ferrières11, Tabassome Simon12, Nicolas Danchin4. 1. Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Cardiology, Hôpital Européen Georges Pompidou (HEGP), Paris, France; Université Paris-Descartes, Paris, France. Electronic address: etienne.puymirat@egp.aphp.fr. 2. AP-HP; HEGP, Department of Critical Care Unit, Paris, France; Université Paris-Descartes, Paris, France. 3. Department of Cardiology, CHU Nîmes, Université de Montpellier, France. 4. Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Cardiology, Hôpital Européen Georges Pompidou (HEGP), Paris, France; Université Paris-Descartes, Paris, France. 5. Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Cardiology, Hôpital Européen Georges Pompidou (HEGP), Paris, France; Université Paris-Descartes, Paris, France; Humanitas Clinical and Research Center, Cardiovascular Department, Rozzano (Milano), Italy. 6. AP-HP; HEGP, Department of Geriatrics, Paris, France; Université Paris-Descartes, Paris, France. 7. Department of Cardiology, Clinique Saint Gatien, Tours, France. 8. Department of Cardiology, Centre Hospitalier de Pontoise, France. 9. Department of Cardiology, Toulouse University Hospital, France. 10. AP-HP, Hôpital Lariboisière, Paris, France. 11. Department of Cardiology B and Epidemiology, Toulouse University Hospital, Toulouse, France; UMR INSERM 1027, Toulouse, France. 12. AP-HP, Department of Clinical Pharmacology and Unité de Recherche Clinique (URCEST), Hôpital Saint Antoine, Paris, France; Université Pierre et Marie Curie (UPMC-Paris 06); INSERM U-698, Paris, France. 13. French Society of Cardiology, Paris, France. 14. Department of Cardiology, University Hospital Jean Minjoz, Besançon, France.
Abstract
BACKGROUND: Elderly patients are underrepresented in acute myocardial infarction trials. Our aim was to determine whether, in elderly patients, changes in management in the past 15 years are associated with improved 1-year mortality after hospital admission for myocardial infarction. METHODS: We used data from 4 1-month French registries, conducted 5 years apart from 1995 to 2010, including 3389 elderly patients (≥75 years of age). RESULTS: From 1995 to 2010, mean age remained stable (82.1 years), similar in ST- and non-ST-elevation myocardial infarction patients. Obesity, diabetes, hypertension, and hypercholesterolemia increased. History of prior myocardial infarction, stroke, and peripheral artery disease remained stable, while history of heart failure decreased. Major changes in management were noted: early percutaneous coronary intervention, early treatment with antiplatelet agents, low-molecular-weight heparin, beta-blockers, angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, and statins all increased. Early mortality after hospital admission decreased from 25.0% to 8.4%. One-year mortality decreased from 36.2% to 20.0% (adjusted hazard ratio 2010 vs 1995: 0.47, 0.39-0.57), both for ST-elevation myocardial infarction (36.8% to 21.1%) and non-ST-elevation myocardial infarction (34.8% to 19.1%). Mortality reduction was observed in all age groups, including those ≥85 years of age (from 46.2% to 31.4%). The study period, however, was no longer associated with decreased mortality when variables reflecting management changes were taken into account. CONCLUSIONS: Early and 1-year mortality after hospital admission of elderly patients with acute myocardial infarction has substantially decreased over the past 15 years. This improvement is likely mediated by increasing use of recommended management strategies. These data support the application of guidelines derived from trials mostly including younger patients to elderly populations as well.
BACKGROUND: Elderly patients are underrepresented in acute myocardial infarction trials. Our aim was to determine whether, in elderly patients, changes in management in the past 15 years are associated with improved 1-year mortality after hospital admission for myocardial infarction. METHODS: We used data from 4 1-month French registries, conducted 5 years apart from 1995 to 2010, including 3389 elderly patients (≥75 years of age). RESULTS: From 1995 to 2010, mean age remained stable (82.1 years), similar in ST- and non-ST-elevation myocardial infarctionpatients. Obesity, diabetes, hypertension, and hypercholesterolemia increased. History of prior myocardial infarction, stroke, and peripheral artery disease remained stable, while history of heart failure decreased. Major changes in management were noted: early percutaneous coronary intervention, early treatment with antiplatelet agents, low-molecular-weight heparin, beta-blockers, angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, and statins all increased. Early mortality after hospital admission decreased from 25.0% to 8.4%. One-year mortality decreased from 36.2% to 20.0% (adjusted hazard ratio 2010 vs 1995: 0.47, 0.39-0.57), both for ST-elevation myocardial infarction (36.8% to 21.1%) and non-ST-elevation myocardial infarction (34.8% to 19.1%). Mortality reduction was observed in all age groups, including those ≥85 years of age (from 46.2% to 31.4%). The study period, however, was no longer associated with decreased mortality when variables reflecting management changes were taken into account. CONCLUSIONS: Early and 1-year mortality after hospital admission of elderly patients with acute myocardial infarction has substantially decreased over the past 15 years. This improvement is likely mediated by increasing use of recommended management strategies. These data support the application of guidelines derived from trials mostly including younger patients to elderly populations as well.
Authors: Gabriele Crimi; Nuccia Morici; Maurizio Ferrario; Luca A Ferri; Luigi Piatti; Daniele Grosseto; Michele Cacucci; Alessandro Mandurino Mirizzi; Anna Toso; Federico Piscione; Marco De Carlo; Luigi Raffaele Elia; Bruno Trimarco; Leonardo Bolognese; Francesco M Bovenzi; Giuseppe De Luca; Stefano Savonitto; Stefano De Servi Journal: J Am Heart Assoc Date: 2019-01-22 Impact factor: 5.501