ST ELEVATION MYOCARDIAL INFARCTION IN ELDERLY AND VERY ELDERLY PATIENTS

Background: During ST elevation myocardial infarction (STEMI) early myocardial reperfusion is the target therapy to salvage ischemic myocardium and to improve survival. Although the mortality from ischemic heart disease has decreased, it appears less consistent in the elderly population. The aim of our study was to evaluate the impact of the age on the time of reperfusion in the elderly STEMI patients (aged>/=75 years) and very elderly patients (aged>/=90 years). Material and Methods: From January 2007 to November 2016, 743 STEMI patients were admitted to our Department. 162 patients (21,8%) had an age>/=75 years (elderly group, EG, mean age 80,9 +/- 4.1), 13 patients (1,7%) had age>/=90 (very elderly group, VEG, mean age 92,5+/-2,3 ) and others 568 patients (76,6%) youngers where the control group ( CG, mean age 58,3+/-9,2). Results: EG patients and VEG patients underwent PPCI with more delay than those in the CG: they had a median door-to-balloon (DTB) time of 84 , 83 minutes respectively vs 65 minutes in CG (p = 0,015) and the proportion of STEMI patients treated with DTB time</= 90 minutes is significantly less in EG an VEG (53% and 61% respectively ) than CG ( 72%, p=0,0001). The EG and VEG had also a longer first medical contact time than CG ( 99.5, 101 and 95 minutes respectively , p= 0,0001) and a longer total ischemic time (respectively 240 and 245 minutes , vs 186,4 minutes p= 0,0001). During hospitalization there were 29 deaths with a mortality rate of 3,9%. Kaplan-Meier analysis showed a significantly lower survival curve in EG and VEG patients (89 and 62 % ) than CG (98,8 %, p= 0,0001). At Cox regression analysis independent predictor of in hospital mortality were age (p=0,0001), ejection fraction (p= 0,002), female sex (0,035), DTB time >90 minutes (p= 0,002) and a FMC>90 minutes (p= 0,04). Conclusions: Our study shows that STEMI network is less efficient in EG and VEG than younger patients. Although the reasons for this is not well understood, we think that in the very elderly population the most frequent comorbidities and a higher risk profile can contribute to complicate the intra- hospital management. Delay in reperfusion, age, sex and myocardial dysfunction are independent predictor of in hospital mortality.