Background: In clinical trials that compare different treatment strategies in patients with acute ST elevation myocardial infarction (STEMI), elderly patients are poorly represented. Aim of this study was to investigate the cost/benefit ratio of invasive versus conservative therapy in STEMI octogenarian patients. Materials and Methods: From April 2009 to January 2014, 153 aged ≥ 80 years were admitted to our CCU diagnosed with STEMI. Patients were followed-up (FU) for 14 (IQ 8-27.5) months and we evaluated the cardiovascular death. Results: Mean age of our study population was 85.2 ± 4.3 yrs, 69 (45 %) were male. On admission, patients had a mean GRACE score of 209 ± 35.1. During hospitalization 122 (79.7 %, group 1) patients underwent coronary angiography within 12 hrs after the onset of symptoms of STEMI and 104 (67.9%) performed primary PCI, 31 (20.2%, group 2) had a conservative therapy. Group 1 were younger (84.2 ± 3.64 vs 87.25 ± 4.9; p=0,0001), and had a lower GRACE score (204.6 ± 30.4vs 218.8 ± 42; p=0,001) with a better LVEF (EF 47.1 ± 12.2 vs 39.9 ± 13.9; p=0,004) on admission. During hospitalization 47 pts died and 11 were lost to FU. At discharge, group 1 was prescribed more thienopyridines (89.4% vs 61.2 %, p=0.001), beta- blockers (69.2% vs 38.7%, p=0.0001) and statins (86.5% vs 47%, p=0.004) than group 2. During FU there were 23 deaths with a mortality rate of 24.2%. Kaplan-Meier analysis showed a significantly lower survival curve in Group 2 patients (50 %) than group 1 (84.5 %, log rank p= 0.0001, chi-square 19.4). In multivariate analysis independent predictor of mortality at FU was a conservative approach (4.83, 95% IC 1.81-12.9, p=0.002) and a low creatinine value (OR 4.04, 95% IC 2.18-7.49, p=0.0001). Conclusions: In elderly patients with STEMI and high risk profile, invasive strategy combined with a more aggressive medical therapy appear a better strategy to improve outcome at FU.
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|Titolo:||INVASIVE VERSUS CONSERVATIVE THERAPY IN OCTOGENARIANS WITH ACUTE ST ELEVATION MYOCARDIAL INFARCTION|
MONTISCI, ROBERTA (Primo)
MELONI, LUIGI (Ultimo)
|Data di pubblicazione:||2015|
|Tipologia:||1.5 Abstract in rivista|