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Sinkovic A, Pehnec Z  
In-Hospital Mortality and Treatment in Elderly Patients with ST-Elevation Myocardial Infarction

Journal für Kardiologie - Austrian Journal of Cardiology 2005; 12 (11-12): 282-284

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Keywords: KardiologieMortalitätST-Hebungs-MyokardinfarktStudieälterer Patientaged patientcardiologymortalityST-elevation myocardial infarctionstudy

Background. In STEMI early reperfusion therapy improves survival irrespective of age, though caution is recommended for iv. fibrinolysis in the elderly due to increased risk for brain haemorrhage. Primary percutaneous coronary intervention (PCI) improves survival in the elderly with STEMI most effectively, if performed without a delay – within 90 minutes from the first medical contact to balloon inflation. If primary PCI is unaccessible, iv. fibrinolysis in comparison to placebo significantly decreases mortality within first few hours of chest pain. Our aim was to compare retrospectively clinical characteristics and inhospital mortality among consecutive STEMI patients ≥ 65 years treated either with primary PCI, or iv. fibrinolysis, or medically, and to evaluate the differences between elderly survivors and non-survivors. Methods. Out of 343 patients with STEMI 171 were ≥ 65 years, treated with iv. fibrinolysis, or primary PCI, or medical therapy. Results. 13.4 % of elderly with STEMI were treated with iv. fibrinolysis, 33.3 % with primary PCI and 42.6 % medically. Among the treatment groups we observed non-significant differences in in-hospital mortality (19.88 % vs. 15.8 % vs 24.65 %, p ≥ 0.05). Between elderly survivors and nonsurvivors we observed significant differences in peak mean Troponin T (4.1 ± 5.2 vs. 6.6 ± 7.3, p < 0.05), in presence of anterior infarction (40 % vs. 73.8 %, p < 0.05) and in admission cardiogenic shock (3.6 % vs. 64.7 %, p < 0.05), but non-significant differences in treatments. Conclusion. In-hospital mortality in the elderly with STEMI was significantly associated with an extensive anterior myocardial infarction with Q and cardiogenic shock on admission.
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