ST-elevation myocardial infarction in the elderly - Temporal Trends in incidence, utilization of percutaneous coronary intervention and outcomes in the United States

BackgroundElderly patients with ST-elevation myocardial infarction (STEMI) are often underrepresented in major percutaneous coronary intervention (PCI) trials. Use of PCI for STEMI, and associated outcomes in patients aged ≥ 65 years with STEMI needed further investigation.MethodsWe used the 2001-2010 United States Nationwide Inpatient Sample (NIS) database to examine the temporal trends in STEMI, use of PCI for STEMI, and outcomes among patients aged 65-79 and ≥ 80 years.ResultsDuring 2001-2010, of 4,017,367 patients aged ≥ 65 years with acute myocardial infarction (AMI), 1,434,579 (35.7%) had STEMI. Over this period, among patients aged 65-79 and ≥ 80 years, STEMI decreased by 16.4% and 19%, whereas the use of PCI for STEMI increased by 33.5% and 22%, respectively (Ptrend < 0.001). There was a significant decrease in age-adjusted in-hospital mortality (per 1000) in patients aged ≥ 80 years (150 versus 116, Ptrend = 0.02) but not in patients aged 65-79 years (63 versus 59, Ptrend = 0.886). Stepwise logistic regression identified intra-aortic balloon pump use, acute renal failure, acute cerebrovascular disease, age ≥ 80 years, peripheral vascular disease, gastrointestinal bleeding, female gender, congestive heart failure, chronic lung disease, weekend admission and multivessel PCI as independent predictors of in-hospital mortality among all patients ≥ 65 years of age who underwent PCI for STEMI.ConclusionsIn this large, multi-institutional cohort of elderly patients, a decreasing trend in STEMI, an increasing trend in PCI utilization for STEMI, and reduction in in-hospital mortality were observed from 2001 to 2010.