Age-Related Mortality in STEMI Patients: Insight from One Year of HUB Centre Experience during the Pandemic
Abstract
:1. Introduction
2. Materials and Methods
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Sliman, H.; Jaffe, R.; Rubinshtein, R.; Karkabi, B.; Zissman, K.; Flugelman, M.Y.; Zafrir, B. Clinical features and outcomes of revascularization in very old patients with left main coronary artery disease. Coron. Artery Dis. 2019, 30, 584–589. [Google Scholar] [CrossRef] [PubMed]
- Engberding, N.; Wenger, N.K. Acute Coronary Syndromes in the Elderly. F1000Research 2017, 6, 1791. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- EVandecasteele, E.H.; De Buyzere, M.; Gevaert, S.; De Meester, A.; Convens, C.; Dubois, P.; Boland, J.; Sinnaeve, P.; De Raedt, H.; Vranckx, P.; et al. Reperfusion therapy and mortality in octogenarian STEMI patients: Results from the Belgian STEMI registry. Clin. Res. Cardiol. 2013, 102, 837–845. [Google Scholar] [CrossRef] [PubMed]
- GRACE Investigators. Rationale and design of the GRACE (Global Registry of Acute Coronary Events) Project: A multinational registry of patients hospitalized with acute coronary syndromes. Am. Heart J. 2001, 141, 190–199. [Google Scholar] [CrossRef] [PubMed]
- De Boer, M.-J.; Ottervanger, J.P.; Suryapranata, H.; Hoorntje, J.C.; Dambrink, J.-H.E.; Gosselink, A.M.; Hof, A.W.V.; Zijlstra, F. Old Age and Outcome After Primary Angioplasty for Acute Myocardial Infarction. J. Am. Geriatr. Soc. 2010, 58, 867–872. [Google Scholar] [CrossRef] [PubMed]
- Kala, P.; Kanovsky, J.; Rokyta, R.; Smid, M.; Pospisil, J.; Knot, J.; Rohac, F.; Poloczek, M.; Ondrus, T.; Holicka, M.; et al. Age—Related treatment strategy and long-term outcome in acute myocardial infarction patients in the PCI era. BMC Cardiovasc. Disord. 2012, 12, 31. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Gudnadottir, G.S.; James, S.K.; Andersen, K.; Lagerqvist, B.; Thrainsdottir, I.S.; Ravn-Fischer, A.; Varenhorst, C.; Gudnason, T. Outcomes after STEMI in old multimorbid patients with complex health needs and the effect of invasive management. Am. Heart J. 2019, 211, 11–21. [Google Scholar] [CrossRef] [PubMed]
- Dai, X.; Busby-Whitehead, J.; E Forman, D.; Alexander, K.P. Stable ischemic heart disease in the older adults. J. Geriatr. Cardiol. 2016, 13, 109–114. [Google Scholar] [CrossRef] [PubMed]
- Tumminello, G.; Barbieri, L.; Lucreziotti, S.; Gentile, D.; Conconi, B.; Centola, M.; Mafrici, A.; Carugo, S. Impact of COVID-19 on STEMI: Second youth for fibrinolysis or time to centralized approach? IJC Heart Vasc. 2020, 30, 100600. [Google Scholar] [CrossRef] [PubMed]
- De Rosa, S.; Spaccarotella, C.; Basso, C.; Calabrò, M.P.; Curcio, A.; Filardi, P.P.; Mancone, M.; Mercuro, G.; Muscoli, S.; Nodari, S.; et al. Reduction of hospitalizations for myocardial infarction in Italy in the COVID-19 era. Eur. Heart J. 2020, 41, 2083–2088. [Google Scholar] [CrossRef] [PubMed]
- De Filippo, O.; D’Ascenzo, F.; Angelini, F.; Bocchino, P.P.; Conrotto, F.; Saglietto, A.; Secco, G.G.; Campo, G.; Gallone, G.; Verardi, R.; et al. Reduced Rate of Hospital Admissions for ACS during COVID-19 Outbreak in Northern Italy. N. Engl. J. Med. 2020, 383, 88–89. [Google Scholar] [CrossRef] [PubMed]
- Williams, B.; Mancia, G.; Spiering, W.; Agabiti Rosei, E.; Azizi, M.; Burnier, M.; Clement, D.L.; Coca, A.; De Simone, G.; Dominiczak, A.; et al. 2018 ESC/ESH Guidelines for the management of arterial hypertensionThe Task Force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH). Eur. Heart J. 2018, 39, 3021–3104. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- American Diabetes Association. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2021. Diabetes Care 2021, 44 (Suppl. S1), S15–S33. [Google Scholar] [CrossRef] [PubMed]
- Lee, S.B.; Oh, J.H.; Park, J.H.; Choi, S.P.; Wee, J.H. Differences in youngest-old, middle-old, and oldest-old patients who visit the emergency department. Clin. Exp. Emerg. Med. 2018, 5, 249–255. [Google Scholar] [CrossRef] [PubMed]
- Madhavan, M.V.; Gersh, B.J.; Alexander, K.P.; Granger, C.B.; Stone, G.W. Coronary Artery Disease in Patients ≥80 Years of Age. J. Am. Coll. Cardiol. 2018, 71, 2015–2040. [Google Scholar] [CrossRef]
- Sabatine, M.C.; Bergmark, B.A.; Murphy, S.A.; O’Gara, P.T.; Smith, P.K.; Serruys, P.W.; Kappetein, A.P.; Park, S.J.; Park, D.W.; Christiansen, E.H.; et al. Percutaneous coronary intervention with drug-eluting stents versus coronary artery bypass grafting in left main coronary artery disease: An individual patient data meta-analysis. Lancet. 2021, 398, 2247–2257. [Google Scholar] [CrossRef] [PubMed]
- Thiele, H.; Zeymer, U.; Neumann, F.-J.; Ferenc, M.; Olbrich, H.-G.; Hausleiter, J.; Richardt, G.; Hennersdorf, M.; Empen, K.; Fuernau, G.; et al. Intraaortic Balloon Support for Myocardial Infarction with Cardiogenic Shock. N. Engl. J. Med. 2012, 367, 1287–1296. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Ferrante, G.; Barbieri, L.; Sponzilli, C.; Lucreziotti, S.; Salerno Uriarte, D.; Centola, M.; Verdoia, M.; Carugo, S. Predictors of Mortality and Long-Term Outcome in Patients with Anterior STEMI: Results from a Single Center Study. J. Clin. Med. 2021, 10, 5634. [Google Scholar] [CrossRef] [PubMed]
- Tegn, N.; Abdelnoor, M.; Aaberge, L.; Endresen, K.; Smith, P.; Aakhus, S.; Gjertsen, E.; Dahl-Hofseth, O.; Ranhoff, A.H.; Gullestad, L.; et al. Invasive versus conservative strategy in patients aged 80 years or older with non-ST-elevation myocardial infarction or unstable angina pectoris (After Eighty study): An open-label randomised controlled trial. Lancet 2016, 387, 1057–1065. [Google Scholar] [CrossRef]
- He, P.; Yang, J.; Xu, H.; Gao, X.; Ying, X.; Yuan, W.; Wei, L.; Yang, W.; Tang, X.; Yan, R. The comparison of the outcomes between primary pci, fibrinolysis, and no reperfusion in patients ≥ 75 years old with st-segment elevation myocardial infarction: Results from the chinese acute myocardial infarction (cami) registry. PLoS ONE 2016, 11, e0165672. [Google Scholar] [CrossRef]
Clinical Characteristics (n) | Tot (283) | Not-O ≤ 74 y/o (189) | O 75–84 y/o (74) | Very-O ≥ 85 y/o (20) | p |
---|---|---|---|---|---|
Age (years) | 66.7 +/− 12.7 | 59.6 +/− 8.8 | 79.0 +/− 3.7 | 87.9 +/− 2.9 | <0.0001 |
BMI (kg/m2) | 26.4 +/− 4.3 | 26.8 +/− 4.2 | 25.2 +/− 4.2 | 26.7 +/− 5.4 | 0.02 |
Hypertension (%) | 55.2 | 45.7 | 78.4 | 84.2 | <0.0001 |
Never smoked (%) | 54.4 | 45.7 | 71.6 | 73.7 | <0.0001 |
Active smoker (%) | 33.4 | 45.7 | 13.5 | 5.3 | |
Previous smoker (%) | 10.7 | 8.5 | 14.9 | 21.1 | |
Dyslipidemia (%) | 28.6 | 31.4 | 28.4 | 15.8 | ns |
Diabetes (%) | 20.0 | 16.5 | 27.0 | 36.8 | 0.03 |
Obesity(%) | 20.0 | 23.9 | 12.2 | 21.1 | ns |
F. history of CAD (%) | 13.4 | 18.6 | 4.1 | 5.3 | 0.005 |
Previous MI (%) | 13.4 | 12.2 | 20.3 | 5.0 | ns |
Previous PCI (%) | 13.1 | 12.7 | 16.2 | 10.0 | ns |
Previous CABG (%) | 2.8 | 2.6 | 2.7 | 5.0 | ns |
COPD (%) | 9.0 | 5.3 | 13.5 | 31.6 | <0.0001 |
Dialysis (%) | 1.1 | 0.5 | 2.7 | 0 | ns |
MI type | |||||
Anterior MI (%) | 45.9 | 48.4 | 40.5 | 60.0 | ns |
Inferior MI (%) | 39.7 | 38.8 | 45.9 | 40.0 | |
Lateral MI (%) | 9.0 | 8.5 | 13.5 | 0 | |
Posterior MI (%) | 2.8 | 4.3 | 0 | 0 | |
Site of diagnosis of MI | |||||
Pre-hospital (%) | 61.0 | 66.7 | 45.2 | 65.0 | 0.009 |
Emergency Room (%) | 33.3 | 28.0 | 49.3 | 25.0 | |
Spoke center (%) | 3.5 | 3.7 | 1.4 | 10.0 | |
Hub hospital Dep. (%) | 2.1 | 1.6 | 4.1 | 0 | |
Out of hospital CA (%) | 7.2 | 10.1 | 2.7 | 0 | ns |
Cardiogenic Shock (%) | 7.9 | 7.4 | 9.5 | 10.0 | ns |
Killip Class>2 (%) | 12.1 | 10.5 | 13.5 | 31.6 | 0.03 |
EF (%) | 48.3 +/− 11.0 | 49.8 +/− 9.7 | 46. 8 +/− 12.5 | 40.1 +/− 13.0 | <0.0001 |
Biochemistry | |||||
Hemoglobin g/dL | 13.7 +/− 1.9 | 14.1 +/− 1.7 | 13.0 +/− 2.1 | 12.7 +/− 2.0 | <0.0001 |
Creatinine mg/dL | 1.00 +/− 0.34 | 0.93 +/− 0.28 | 1.10 +/− 0.37 | 1.27 +/− 0.56 | <0.0001 |
Glycemia mg/dL | 155 +/− 72 | 73 +/− 5 | 71 +/− 8 | 67 +/− 15 | ns |
Total cholesterol mg/dL | 171 +/− 46 | 175 +/− 43 | 166 +/− 56 | 149 +/− 22 | ns |
LDL cholesterol mg/dL | 104 +/− 41 | 109 +/− 41 | 98 +/− 43 | 82 +/− 28 | 0.01 |
Troponin T ng/L | 6157 +/− 3224 | 5902 +/− 11000 | 6561 +/− 10402 | 7085 +/− 7780 | ns |
Procedural Characteristics (n) | TOT (283) | Not-O ≤ 74 y/o (189) | O 75–84 y/o (74) | Very-O ≥ 85 y/o (20) | p |
---|---|---|---|---|---|
Radial approach (%) | 73.8 | 77.1 | 74.3 | 70.0 | ns |
Multivessel disease (%) | 54.5 | 53.7 | 58.1 | 70.0 | ns |
N° of critical vessels | 1.78 +/− 0.80 | 1.71 +/− 0.79 | 1.92 +/− 0.82 | 1.90 +/− 0.85 | ns |
Critical left main (%) | 5.5 | 3.2 | 12.2 | 5.0 | 0.01 |
Culprit vessel LAD (%) | 45.0 | 45.2 | 42.5 | 52.6 | ns |
SYNTAX score | 17.7 | 16.8 | 16.9 | 19.2 | ns |
IABP (%) | 4.8 | 4.2 | 8.1 | 0 | ns |
Final TIMI flow ≥ 2 (%) | 96.1 | 97.3 | 91.8 | 100 | ns |
Comp. revasc. during index procedure (%) | 4.5 | 11.0 | 2.3 | 7.1 | ns |
Comp. revasc. during hospitalization (%) | 62.4 | 67.0 | 53.5 | 55.1 | ns |
Total ischemic time (min) | 273 +/− 367 | 262 +/− 390 | 302 +/− 324 | 269 +/− 300 | ns |
COVID-19 characterization | |||||
COVID-19 + (%) | 8.6 | 9.6 | 8.2 | 5.0 | ns |
Ventilatory mechanical support (%) | 7.2 | 9.1 | 10.9 | 18.2 | ns |
Therapy at discharge | |||||
B-blocker (%) | 88.2 | 91.7 | 84.8 | 62.5 | 0.002 |
ACE-I (%) | 71.0 | 77.2 | 59.1 | 50.0 | 0.003 |
ARBs (%) | 9.2 | 7.2 | 15.2 | 7.3 | ns |
Acetylsalicylic acid (%) | 98.9 | 99.5 | 97.1 | 100 | ns |
DAPT (%) | 93.3 | 95.2 | 90.5 | 85.0 | ns |
Statin (%) | 97.0 | 96.7 | 98.5 | 93.8 | ns |
Direct anticoagulant (%) | 6.1 | 2.8 | 15.2 | 6.3 | 0.002 |
In-hospital events | |||||
In-hospital mortality (%) | 11.4 | 7.4 | 17.6 | 30.0 | 0.02 |
MACE (%) | 15.9 | 10.6 | 24.3 | 35.0 | 0.001 |
Respiratory complications (%) | 6.4 | 5.8 | 8.1 | 5.0 | ns |
Cardiac death (%) | 7.9 | 4.2 | 13.5 | 25.0 | 0.001 |
Hospitalization days | 9.4 +/− 7.3 | 8.8 +/− 7.3 | 10.6 +/− 7.5 | 11.0 +/− 4.4 | ns |
Follow-up events | |||||
Follow-up (days) | 430 +/− 208 | 459 +/− 178 | 396 +/− 238 | 283 +/− 276 | 0.0001 |
Follow-up median and interquartile distance (days) | 464–271 | 467–245 | 458–391 | 247–580 | |
Death from any cause from index procedure (%) | 18.0 | 10.1 | 29.7 | 50.0 | 0.0001 |
Death from any cause after discharge (%) | 7.2 | 2.9 | 14.8 | 28.6 | 0.0001 |
Variable | OR | [CI] | p | |
---|---|---|---|---|
Overall Population | ||||
EF | 0.90 | 0.868–0.938 | <0.0001 | |
COVID-19 + | 3.17 | 1.212–8.331 | ns | |
Killip class > 2 | 2.12 | 0.918–4.935 | 0.07 | |
Age | 1.00 | 0.963–1.039 | ns | |
Not Old ≤ 74 y/o | ||||
EF | 0.893 | 0.828–0.962 | 0.003 | |
COVID-19 + | 1.995 | 0.491–8.106 | ns | |
Killip class > 2 | 1.099 | 0.189–6.396 | Ns | |
Out of hospital CA (%) | 4.283 | 0.777–23.619 | 0.095 | |
Old 75–84 y/o | ||||
EF | 0.919 | 0.876–0.965 | 0.001 | |
Killip class > 2 | 1.622 | 0.431–6.107 | ns | |
Very Old ≥ 85 y/o | ||||
EF | 0.905 | 0.832–0.984 | 0.019 |
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Tumminello, G.; D’Errico, A.; Maruccio, A.; Gentile, D.; Barbieri, L.; Carugo, S. Age-Related Mortality in STEMI Patients: Insight from One Year of HUB Centre Experience during the Pandemic. J. Cardiovasc. Dev. Dis. 2022, 9, 432. https://doi.org/10.3390/jcdd9120432
Tumminello G, D’Errico A, Maruccio A, Gentile D, Barbieri L, Carugo S. Age-Related Mortality in STEMI Patients: Insight from One Year of HUB Centre Experience during the Pandemic. Journal of Cardiovascular Development and Disease. 2022; 9(12):432. https://doi.org/10.3390/jcdd9120432
Chicago/Turabian StyleTumminello, Gabriele, Andrea D’Errico, Alessio Maruccio, Domitilla Gentile, Lucia Barbieri, and Stefano Carugo. 2022. "Age-Related Mortality in STEMI Patients: Insight from One Year of HUB Centre Experience during the Pandemic" Journal of Cardiovascular Development and Disease 9, no. 12: 432. https://doi.org/10.3390/jcdd9120432