The Impact of Advanced Age on Major Cardiovascular Events and Mortality in Patients with ST-Elevation Myocardial Infarction Undergoing a Pharmaco-Invasive Strategy

Figures & data

Table 1 Baseline Clinical Characteristics

	Age <75 Years (n=1692)	Age ≥75 Years (n=160)	p value
Age, years	56.09 ± 9.68	79.50±3.90	<0.001
Female	490/1692 (29.0%)	69/160 (43.1%)	˂0.001
Body mass index, kg/m^2	26.84 ± 4.83	25.53±4.17	<0.001
Diabetes	499/1684 (29.6%)	68/159 (42.8%)	<0.001
Smoking	1115/1681 (61%)	62/159 (39%)	<0.001
Hypertension	1009/1683 (60.0%)	125/159 (79.0%)	<0.001
Dyslipidemia	886/1682 (52.7%)	78/159 (49.0%)	0.38
Hypothyroidism	94/1680 (5.6%)	20/159 (12.5%)	0.007
Peripheral vascular disease	97/1683 (5.8%)	14/159 (8.8%)	0.13
Prior myocardial infarction	174/1683 (10.3%)	23/159 (14.5%)	0.11
Prior stroke	68/1683 (4.0%)	15/159 (9.4%)	0.002
Prior percutaneous coronary intervention	99/1683 (5.9%)	12/159 (7.5%)	0.40
Prior coronary artery bypass grafting	32/1681 (1.9%)	6/159 (3.8%)	0.14
Creatinine, mg/dL (SD)	1.05 ± 0.37	1.35±0.51	0.04
eGFR*, mL/min	92.40 ± 38.5	62.02±29.01	<0.001
<60 mL/min	248/1617 (15.3%)	61/152 (40.1%)	<0.001
Atypical chest pain	134/1680 (8.0%)	24/159 (15.1%)	0.009
Killip class 3/4	164/1688 (9.7%)	35/159 (22%)	<0.001
GRACE	137.8 ± 37.4	188.3±37.8	<0.001
TIMI Score
Low risk	654/1635 (40%)	0/151 (0%)	<0.001
Intermediate risk	548/1635 (33.5%)	21/151 (13.9%)	<0.001
High risk	433/1635 (26.5%)	130/151 (86.1%)	<0.001

Notes: Values are n/N (%), mean±standard deviation. Prior stroke occurred over 3 months at the index procedure. *Estimated by Modification of Diet in Renal Disease (MDRD) equation.

Abbreviations: eGFR, estimated glomerular filtration rate; GRACE, Global Registry of Acute Coronary Events.

Table 2 Procedural Characteristics Between Patients Age ˂75 Years and Age ≥75 Years

	Age <75 Years (n=1692)	Age ≥75 Years (n=160)	p value
Number of Stents Implanted			0.04
0	563/1681 (33.5%)	58/160 (36.2%)
1	869/1681 (51.7%)	86/160 (53.8%)
2	218/1681 (13%)	12/160 (7.5%)
≥3	31/1681 (1.8%)	4/160 (2.5%)
Pain onset to fibrinolysis, mean, min	1638/1692 (383.60 ± 660.83)	155/160 (443.19 ± 887.10)	0.30
Pain onset to fibrinolysis, median, min	220 (0–7208)	240 (39–7208)
Door-to-needle time, min	1625/1692 (116.24 ± 161.39)	149/160 (115.90 ± 118.89)	0.98
Fibrinolysis to coronary angiography, hrs	11.1 ± 6.9	13.3 ± 6.2	0.24
Ischemic Time			0.91
<15 min	53/1638 (3.2%)	4/160 (2.5%)
15 to 30 min	96/1638 (5.9%)	9/160 (5.5%)
>30 min to 1 hour	129/1638 (7.9%)	12/160 (7.5%)
>1 to 2 hours	228/1638 (13.9%)	26/160 (16.5%)
>2 hours	1132/1638 (69.1%)	109/160 (68%)
Baseline TIMI Flow			0.06
0/1/2	555/1638 (35.9%)	64/160 (44.8%)
3	991/1638 (64.1%)	79/160 (55.2%)
Final TIMI Flow			<0.001
0/1/2	260/1508 (17.2%)	46/140 (32.9%)
3	1248/1508 (82.8%)	94/140 (67.1%)
Final Myocardial Blush			<0.001
0/1/2	575/1505 (38.2%)	77/140 (55.0%)
3	930/1505 (61.8%)	63/140 (45.0%)

Note: Values are n/N (%), mean±standard deviation.

Abbreviation: TIMI, Thrombolysis in Myocardial Infarction.

Table 3 In-Hospital Clinical Outcomes Between Patients Age ˂75 Years and Age ≥75 Years

	Age <75 Years (n=1692)	Age ≥75 Years (n=160)	p value
Cardiogenic shock	117/1683 (7.0%)	31/158 (19.6%)	<0.001
No reflow	73/1683 (4.3%)	16/160 (10%)	<0.001
Re-infarction	33/1683 (2%)	3/156 (1.9%)	0.97
Urgent coronary angiography	495/1683 (29%)	49/160 (30%)	0.75
Stroke	32/1683 (1.9%)	4/159 (2.5%)	0.59
Hemorrhagic	15/1683 (0.9%)	1/159 (0.6%)	0.73
Ischemic	17/1683 (1%)	3/159 (2%)	0.31
All-cause death	68/1684 (4.0%)	29/159 (18.2%)	<0.001
Major adverse cardiac events	109/1683 (6.5%)	31/160 (19.4%)	<0.001
Major bleeding	6/1683 (2.7%)	9/159 (5.6%)	0.04

Note: Values are n/N (%).

Table 4 Multivariable Logistic Regression Model for Major Adverse Cardiac Events and Death

	Odds Ratio	95% Confidence Interval	p value
Major Adverse Cardiac Events
≥75 Years	3.57	1.72–7.42	0.001
Female	2.30	1.23–4.30	0.009
Killip class 3 or 4	14.75	7.77–28.03	<0.001
Fasting glucose (×10)	1.06	1.03–1.09	<0.001
Major bleeding	4.83	2.00–11.64	<0.001
Death
≥75 Years	2.07	1.12–3.82	0.02
Female	1.90	1.18–3.05	0.008
Killip class 3 or 4	6.82	4.11–11.33	<0.001
Fasting glucose (×10)	1.04	1.01–1.06	0.003
Major bleeding	3.46	1.60–7.51	0.002