Outcomes after primary percutaneous coronary intervention in octogenarians and nonagenarians with ST-segment elevation myocardial infarction: from the Western Denmark heart registry

BACKGROUND: Elderly patients with ST segment elevation myocardial infarction (STEMI) constitute a particular risk group in relation to primary percutaneous coronary intervention (PPCI).

OBJECTIVE: We examined the proportion of octogenarians and nonagenarians undergoing PPCI in Western Denmark, and their short- and long-term mortality rates.

METHODS: From 2002 to 2009 all consecutive patients ≥ 80 years with STEMI treated with PPCI were identified in the population based Western Denmark Heart Registry. Cox regression analysis was used to compute hazard ratios, controlling for potential confounding.

RESULTS: A total of 1,322 elderly (1,213 octogenarians and 109 nonagenarians), corresponding to 11.6% of the total PPCI treated STEMI population were treated with PPCI between 2002 and 2009. The annual proportion of octogenarians referred for PPCI increased from n = 52 (6.2%) in 2002 to n = 172 (11.8%) in 2009 (P < 0.01), while it remained unchanged in nonagenarians: n = 6 (0.6%) in 2002 to n = 13 (0.8%) in 2009 (P = ns). For octogenarians and nonagenarians, 30-day mortality was 17.2% versus 25.8% (log-rank P = 0.028), 1-year mortality was 27.6% versus 32.5% (log-rank P = 0.18) and 5-year mortality 53.6% versus 57.3% (log-rank P = 0.087), respectively. Adjusted 30-day hazard ratio (HR) = 1.59 (95% confidence interval = CI: 1.07-2.36), 1-year HR = 1.34 (CI: 0.95-1.90), and 5-year mortality HR = 1.39 (CI: 1.04-1.85) was higher in nonagenarians compared with octogenarians.

CONCLUSION: The annual proportion of octogenarians with STEMI treated with PPCI doubled from 2002 to 2009, while the proportion of nonagenarians remained unchanged. Although nonagenarians had the highest short- and long-term mortality, we found the outcome acceptable with a 5-year survival of more than 40% in both groups.