Elderly patients with myocardial infarction selected for conservative or invasive treatment strategy

Figures & data

Table 1 Age, sex, and previous history (%, unless otherwise stated)

	2001		2007		2001+2007		P*	P**
	Cons (n=706)	Inv (n=97)	Cons (n=463)	Inv (n=147)	Cons (n=1,169)	Inv (n=244)
Age (mean ± SD; years)	84±5	79±3	85±5	81±4	84±5	80±4	<0.0001	0.33
Women	53	40	57	46	55	43	0.053	0.83
Past medical history
Risk factors for AMI
Hypertension	54	59	57a	59a	55a	59a	0.48	0.71
Diabetes	21	20	28	24	24	22	0.18	0.69
Smoking at time of arrival	10c	14	7	11a	9b	12a	0.64	0.89
Previous heart disease
Acute myocardial infarction	44	31a	44	36	44	34	0.03	0.59
Angina pectoris	48	38	31a	32a	41a	35a	0.34	0.19
Cardiac arrest	1a	2	0	0a	<1	< 1	1.00	–
CABG	8	6	12	14a	10	11	0.41	0.37
PCI	3	8	7	19a	4	14	<0.0001	0.76
Congestive heart failure	44	16	36	11	41	13	<0.0001	0.69
Atrial fibrillation	29	8	27	20a	28	15a	0.001	0.003
Other vascular disease
Peripheral vascular disease	14a	20	13	9	14	13	0.44	0.04
Cerebrovascular disease	25	12	24	13	24	13	0.0002	0.77
Other disease
COPD	12	10	13	10	12	10	0.03	0.67
Connective tissue disease	3	0	0	0	2	0	0.03	–
Non-metastatic tumor	11a	7	6	4	9	5	0.09	0.82
Metastatic tumor	6a	3	12	6	9	5	0.08	0.97
Renal disease	9a	8	13	7	9	7	0.08	0.27
Treated at hospital with PCI facilities	48	75	55	56	51	64	0.003	0.0001

Notes:

* For difference between conservative and invasive treated groups (age adjusted);

** for time period by treatment interaction;

a 1%–5% missing;

b 5%–10% missing;

c 10%–25% missing.

Abbreviations: Cons, conservative; Inv, invasive; SD, standard deviation; CABG, coronary artery bypass graft; PCI, percutaneous coronary intervention; COPD, chronic obstructive pulmonary disease; AMI, acute myocardial infarction.

Table 2 Presentation (%)

	2001		2007		2001+2007		P*	P**
	Cons (n=706)	Inv (n=97)	Cons (n=463)	Inv (n=147)	Cons (n=1,169)	Inv (n=244)
Symptoms
Chest pain/pressure/discomfort	81a	98	68a	90	76a	93	<0.0001	0.18
Loss of consciousness	7a	5	9	5	8a	5	0.13	0.79
Pulmonary edema or cardiogenic shock	7	5	10	8	8	7	0.24	0.81
Other at presentation
Cardiogenic shock	1a	0	< 1a	3	1a	2	0.27	0.15
Congestive heart failure	45	15	52a	27a	48a	22a	<0.0001	0.28
ECG recording available#	46	77	85	84	61	82	<0.0001	0.0001
ST elevation	9	23	7	28	8	26	<0.0001	0.15
Location
Anterior	8	20	6	19	7	19	<0.0001	0.55
Inferior	2	9	2	15	2	13	<0.0001	0.26
Lateral	0	3	0	2	0	3	0.0005	1.00
ST-depression	27	31	25	35	26	33	0.008	0.45
LBBB	15	8	15	8	15	8	0.005	0.96
Other pathological ECG changes	50	59	44	49	46	53	0.09	0.74
Normal ECG	23	20	27	19	25	20	0.10	0.54
Sinus rhythm	67	81	68	76	68	78	0.07	0.45

Notes:

* For difference between conservative and invasive treatment strategy groups (age adjusted);

** for time period by treatment interaction;

# percentages below refer to patients with available ECG recordings;

a 1%–5% missing.

Abbreviations: Cons, conservative; Inv, invasive; ECG, electrocardiogram; LBBB, left bundle branch block.

Table 3 In-hospital procedures and events (%)

	2001		2007		2001+2007		P*	P**
	Cons (n=706)	Inv (n=97)	Cons (n=463)	Inv (n=147)	Cons (n=1,169)	Inv (n=244)
Thrombolysis	4	16	< 1	0	3	7	0.04	0.18
Procedures and treatment
Echocardiography	31	82	25	70	29	75	<0.0001	0.29
Exercise bicycle test	6	20a	2	2a	4	9a	0.61	0.08
PCI	0	42	0	75	0	62	–	–
Primary	0	33a	0	65	0	52	–	–
Rescue	0	7a	0	0	0	3	–	–
Elective	0	1a	0	10	0	6	–	–
CABG	<1	27	< 1	7	< 1	15	<0.0001	0.21
Events
Recurrent AMI	3	6	2	4	2	5	0.01	0.94
Pulmonary embolism	<1a	0	2	0	1	0	0.07	1.00
Pneumonia	12a	6	9	1	10a	3	0.0005	0.13
Stroke	6a	4	3	< 1	5	2	0.11	0.22
Deep vein thrombosis	<1a	1	< 1	0	< 1	< 1	1.00	0.75
Acute renal failure	4a	1	2	< 1	4	< 1	0.055	0.91
Hemorrhage requiring transfusion	4a	0	6	1	5	< 1	0.01	0.22
Hypotension	14a	5	16	18	15	13	0.35	0.02
Pericarditis	0a	1	0	< 1	0	< 1	0.046	1.00
Cardiogenic shock	3a	3	2	3	2	3	0.87	0.50
Congestive heart failure	54	29	19	13	40	19	<0.0001	0.11
Death	20	6	20	10	20	9	0.0003	0.31

Notes:

* for difference between conservative and invasive treated groups (age adjusted);

** for time period by treatment interaction;

a 1%–5% missing.

Abbreviations: Cons, conservative; Inv, invasive; CABG, coronary artery bypass graft; PCI, percutaneous coronary intervention; AMI, acute myocardial infarction.

Figure 1 Kaplan-Meier curve describing survival in elderly patients with MI related to treatment strategy group.

Abbreviation: MI, myocardial infarction.