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Trends and impact of door-to-balloon time on clinical outcomes in patients aged <75, 75 to 84, and ≥85 years with ST-Elevation myocardial infarction

Version 2 2024-06-03, 21:26
Version 1 2021-02-04, 08:07
journal contribution
posted on 2024-06-03, 21:26 authored by M Yudi, G Hamilton, O Farouque, N Andrianopoulos, SJ Duffy, J Lefkovits, A Brennan, D Fernando, Chin HiewChin Hiew, M Freeman, C Reid, R Dakis, AE Ajani, DJ Clark, JA Shaw, A Walton, A Dart, A Broughton, J Federman, C Keighley, C Hengel, KH Peter, D Stub, W Chan, J O'Brien, L Selkrig, K Rankin, R Vandernet, R Huntington, S Pally, M Horrigan, J Johns, L Oliver, J Brennan, R Chan, G Proimos, T Dortimer, B Chan, V Nadurata, R Huq, A Al-Fiadh, H Sugumar, J Ramchand, H Han, S Picardo, L Brown, E Oqueli, A Sharma, B Zhu, N Ryan, T Harrison, G New, L Roberts, M Rowe, Y Cheong, C Goods, A Teh, S Parfrey, J Ramzy, A Koshy, P Venkataraman, D Flannery, M Sebastian, T Yip, Michael MokMichael Mok, C Jaworski, A Hutchinson, C Cimenkaya, P Ngu, B Khialani, H Salehi, M Turner, J Dyson, B McDonald, D Van Den Nouwelant, K Halliburton, H Krum, V Chand, D Dinh, BP Yan, R Warren, D Eccleston, R Iyer, R Gurvitch, W Wilson, M Brooks, S Biswas, J Yeoh
Guidelines strongly recommend patients with ST-elevation myocardial infarction (STEMI) receive timely mechanical reperfusion, defined as door-to-balloon time (DTBT) ≤90 minutes. The impact of timely reperfusion on clinical outcomes in patients aged 75–84 and ≥85 years is uncertain. We analysed 2,972 consecutive STEMI patients who underwent primary percutaneous coronary intervention from the Melbourne Interventional Group Registry (2005–2014). Patients aged <75 years were included in the younger group, those aged 75–84 years were in the elderly group and those ≥85 years were in the very elderly group. The primary endpoints were 12-month mortality and major adverse cardiovascular events (MACE). 2,307 (77.6%) patients were <75 years (mean age 59 ± 9 years), 495 (16.7%) were 75–84 years and 170 (5.7%) were ≥85 years. There has been a significant decrease in DTBT over 10 years in younger and elderly patients (p-for-trend <0.01 and 0.03) with a trend in the very elderly (p-for-trend 0.08). Compared to younger and elderly patients, the very elderly had higher 12-month mortality (3.6% vs 10.7% vs. 29.4%; p = 0.001) and MACE (10.8% vs 20.6% vs 33.5%; p = 0.001). DTBT ≤90 minutes was associated with improved outcomes on univariate analysis but was not an independent predictor of improved 12-month mortality (OR 0.84, 95% CI 0.54–1.31) or MACE (OR 0.89, 95% CI 0.67–1.16). In conclusion, over a 10-year period, there was an improvement in DTBT in patients aged <75 years and 75–84 years however DTBT ≤90 minutes was not an independent predictor of 12-month outcomes. Thus assessing whether patients aged ≥85 years are suitable for invasive management does not necessarily translate to worse clinical outcomes.

History

Journal

American journal of cardiology

Volume

120

Pagination

1245-1253

Location

Amsterdam, The Netherlands

ISSN

0002-9149

eISSN

1879-1913

Language

eng

Publication classification

C1 Refereed article in a scholarly journal

Issue

8

Publisher

Elsevier

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