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Benefits from revascularisation therapy in the elderly with acute myocardial infarction. Comparative analysis of patients hospitalised in 1992-1996 and in 2005-2006.

BACKGROUND
Coronary artery disease in the elderly is associated with multilevel atherosclerosis and chronic co-morbidities.


AIM
To determine benefits from revascularisation in the elderly.


METHODS
A total of 830 patients over 65 years with ST-segment elevation myocardial infarction (STEMI) were included. Of them, 339 admitted in 1992-1996 (38.5% STEMI population hospitalised in 1992-1996) (group 1) and 491 (55.2% STEMI population) admitted in 2005-2006 (group 2) were compared. We examined patient characteristics, the course of hospitalisation, the type of therapy and its effect on in-hospital and long-term prognosis (6-month follow-up).


RESULTS
The proportion of patients over 65 has increased significantly from 38.5% in 1992-1996 to 55.2% in 2005-2006 (p < 0.001). In 1992-1996 fibrinolysis was administered in 11.2% of patients while 88.8% received conservative treatment. In 2005-2006 reperfusion therapy was used in 52.2% of patients (15.1% fibrinolysis, 37.1% primary angioplasty). The in-hospital and 6-month mortality tended to be lower in the more recent group (21.5% v. 18.5% and 28% v. 23.8%, NS, respectively). In group 1 there were 22.6% of deaths among those receiving conservative treatment versus 13.2% in patients submitted to reperfusion (p = 0.18). In group 2 in-hospital mortality was the lowest in patients undergoing invasive treatment which was associated with a 62% decrease in 6-month mortality as compared with those receiving conservative treatment (p < 0.001).


CONCLUSIONS
Invasive treatment significantly improves in-hospital and long-term survival in older patients with STEMI. Lack of mortality reduction was related to worse clinical presentation of the currently hospitalised older patient.