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Title: Trends and impacts of door-to-balloon time on clinical outcomes in patients aged <75, 75 to 84, and >85 years with ST-elevation myocardial infarction.
Author: Yudi, Matias B.
Hamilton, Garry
Farouque, Omar
Andrianopoulos, Nick
Duffy, Stephen J.
Lefkovits, Jeffrey
Brennan, Angela
Fernando, Dharsh
Hiew, Chin
Freeman, Melanie
Reid, Christopher M.
Dakis, Robynne
Ajani, Andrew E.
Clark, David J.
Institutional Author: Melbourne Interventional Group
Issue Date: 2017
Publication Title: The American Journal of Cardiology
Volume: 120
Issue: 8
Start Page: 1245
End Page: 1253
Abstract: 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.
Description: Ballarat Health Services staff E. Oqueli, C. Hengel, A. Sharma, B. Zhu, N. Ryan and T. Harrison were included in the list of Data Managers and Institutions participating in the Melbourne Intervention Group (MIG) Database on which this article is based.
ISSN: 0002-9149
Internal ID Number: 01082
Health Subject: AGED
Type: Journal Article
Appears in Collections:Research Output

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