Primary Percutaneous Coronary Intervention for ST Elevation Myocardial Infarction in Octogenarians; Trends and Outcomes

Objective: The general population is gradually aging in the Western world. Therefore, the number of octogenarians undergoing primary Percutaneous Coronary Intervention (PCI) for ST-Elevation Myocardial Infarction (STEMI) is increasing. We aim to provide insight in temporal trends in the annual proportions of octogenarians among STEMI patients undergoing primary PCI and their clinical characteristics and outcomes over an eleven-year observational period. Design: Single-centre observational study. Patients: Between 1997 and 2007, we treated 4506 STEMI patients with primary PCI at our institution. Patients aged >80 years were identified. Main outcome measures: We analyzed temporal trends in the annual proportion of octogenarian STEMI patients, and their baseline characteristics, 30-days and one-year mortality. Results: A total of 379 octogenarians (8.4% of the total population) were treated with primary PCI between 1997 and 2007. Over time, the annual proportion of octogenarians gradually increased from 4/113 (3.5%) in 1997 to 51/579 (8.8%) in 2007 (p for trend <0.01). In the total cohort of 379 patients, 30-day mortality was 21% (81 patients), one-year mortality was 28% (107patients). There was no improvement in survival among octogenarian STEMI patients over the eleven-year study period. Conclusion: The annual proportion of octogenarian STEMI patients increased significantly over the eleven-year study period. Mortality among these high-risk patients was high and did not improve during the study period. Unfortunately, little is known about the optimal treatment of the elderly as they are underrepresented in many randomized clinical trials. Further studies into the optimal STEMI management strategy for the elderly are warranted.