Abstract and Introduction
Abstract
There is no age limit for reperfusion therapy in the current guidelines for the treatment of patients with ST-elevation myocardial infarction (STEMI). Reperfusion therapy, although associated with better outcomes, is not always offered to the oldest patients. A retrospective analysis at our institution of all patients greater than or equal to 90 years of age with a diagnosis of acute coronary syndrome at discharge from 2004 to 2008 identified 24 patients with STEMI. The majority of patients were Caucasian, females, hypertensive, with a low incidence of dementia and diabetes. Only 29% of patients presented to the hospital in less than 6 hours. Thirteen patients were treated with percutaneous coronary intervention (PCI) and 11 patients were treated medically. The in-hospital mortality was 23% in the PCI group and 36% in the medical therapy group. Kaplan-Meier analysis demonstrated a survival benefit favoring PCI, which disappeared when only patients presenting after 6 hours to the hospital were analyzed. PCI-treated patients had no procedure-associated complications and had a good prognosis if they survived to hospital discharge. PCI should be offered to nonagenarians presenting with STEMI.
Introduction
The elderly represent the fastest-growing segment of the United States population and heart disease remains the leading cause of death for both men and women of all ages. It is estimated that by 2020, there will be 2.6 million nonagenarians and 135,000 centenarians in the U.S. However, there are limited data regarding the outcome, clinical course and management of acute coronary syndromes (ACS) in nonagenarians. Despite the general acceptance that patients with STEMI should undergo primary PCI if available, regardless of age, there are scarce data in the nonagenarian population. The purpose of this study was to evaluate the outcome of STEMI in nonagenarians.