Paul Michael Haller1,2, Bernhard Jäger3,4, Serdar Farhan3,4, Günter Christ5,4, Wolfgang Schreiber6,4, Franz Weidinger7,4, Thomas Stefenelli8,4, Georg Delle-Karth9,4, Alfred Kaff10,4, Gerald Maurer11,4, Kurt Huber12,13. 1. 3rd Medical Department, Cardiology and Intensive Care Medicine, Wilhelminenhospital, Montleartstraße 37, 1160, Vienna, Austria. paul.haller@meduniwien.ac.at. 2. Vienna STEMI Registry Group, Vienna, Austria. paul.haller@meduniwien.ac.at. 3. 3rd Medical Department, Cardiology and Intensive Care Medicine, Wilhelminenhospital, Montleartstraße 37, 1160, Vienna, Austria. 4. Vienna STEMI Registry Group, Vienna, Austria. 5. 5th Medial Department, Cardiology, Sozialmedizinisches Zentrum Süd, Vienna, Austria. 6. Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria. 7. 2nd Medical Department, Cardiology, Krankenhaus Rudolfstiftung, Vienna, Austria. 8. 1st Medical Department, Cardiology, Sozialmedizinisches Zentrum Ost, Vienna, Austria. 9. 4th Medical Department, Cardiology, Krankenhaus Hietzing, Vienna, Austria. 10. Ambulance Services Vienna, Vienna, Austria. 11. Department of Cardiology, Medical University of Vienna, Vienna, Austria. 12. 3rd Medical Department, Cardiology and Intensive Care Medicine, Wilhelminenhospital, Montleartstraße 37, 1160, Vienna, Austria. kurt.huber@meduniwien.ac.at. 13. Vienna STEMI Registry Group, Vienna, Austria. kurt.huber@meduniwien.ac.at.
Abstract
BACKGROUND AND AIM: Our senescent society includes a growing number of elderly people suffering from ST-elevation myocardial infarction (STEMI); however, exactly this population is often underrepresented in randomized trials. Hence, our aim was to investigate the influence of age on patient characteristics, as well as short- and long-term outcome in the Vienna STEMI registry. METHODS: We included all patients of the Vienna STEMI registry (2003-2009). Patients were stratified into age cohorts (≤45, 46-59, 60-79 and ≥80 years, respectively). Differences between cohorts were investigated by descriptive statistics and regression models. Crude and adjusted mortality rates were investigated using log rank test and Cox regression models, respectively. The influence of treatment on mortality was further investigated using propensity score matching. RESULTS: A total of 4579 patients fulfilled the criteria for further investigation. With rising age of cohorts, the number of females, diabetes mellitus (DM), hypertension (HTN), previous myocardial infarction (MI), shock, no reperfusion therapy and anterior wall infarction significantly increased. In contrast, the number of patients with a positive family history, smoking and hyperlipidemia (HLP) significantly declined. Log rank analysis showed significant differences between age cohorts for short- and long-term mortality. Cox regression analysis for short-term mortality revealed an independent association for age at the event, HTN and shock, while age, smoking, DM, HTN, HLP, previous MI and shock independently influenced long-term mortality after correction for confounders. Also, we found a significant association of age and total ischemic time (TIT), which however had no influence on long-term mortality (interaction term p = 0.236). Propensity score matching revealed reduced mortality rates for patients who received reperfusion therapy compared to conservative management, irrespective of age. CONCLUSIONS: Increasing age independently influenced short- and long-term mortality in patients with STEMI in the Vienna STEMI network. The TIT significantly increased with baseline age, but had no impact on mortality. Furthermore, reperfusion therapy exerted beneficial effects irrespective of the patients' age.
BACKGROUND AND AIM: Our senescent society includes a growing number of elderly people suffering from ST-elevation myocardial infarction (STEMI); however, exactly this population is often underrepresented in randomized trials. Hence, our aim was to investigate the influence of age on patient characteristics, as well as short- and long-term outcome in the Vienna STEMI registry. METHODS: We included all patients of the Vienna STEMI registry (2003-2009). Patients were stratified into age cohorts (≤45, 46-59, 60-79 and ≥80 years, respectively). Differences between cohorts were investigated by descriptive statistics and regression models. Crude and adjusted mortality rates were investigated using log rank test and Cox regression models, respectively. The influence of treatment on mortality was further investigated using propensity score matching. RESULTS: A total of 4579 patients fulfilled the criteria for further investigation. With rising age of cohorts, the number of females, diabetes mellitus (DM), hypertension (HTN), previous myocardial infarction (MI), shock, no reperfusion therapy and anterior wall infarction significantly increased. In contrast, the number of patients with a positive family history, smoking and hyperlipidemia (HLP) significantly declined. Log rank analysis showed significant differences between age cohorts for short- and long-term mortality. Cox regression analysis for short-term mortality revealed an independent association for age at the event, HTN and shock, while age, smoking, DM, HTN, HLP, previous MI and shock independently influenced long-term mortality after correction for confounders. Also, we found a significant association of age and total ischemic time (TIT), which however had no influence on long-term mortality (interaction term p = 0.236). Propensity score matching revealed reduced mortality rates for patients who received reperfusion therapy compared to conservative management, irrespective of age. CONCLUSIONS: Increasing age independently influenced short- and long-term mortality in patients with STEMI in the Vienna STEMI network. The TIT significantly increased with baseline age, but had no impact on mortality. Furthermore, reperfusion therapy exerted beneficial effects irrespective of the patients' age.
Entities:
Keywords:
Age; Mortality; STEMI; Total ischemic time
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