15-Year Data Show a Significant Improvement in One-Year Mortality in Elderly AMI Patients

August 30, 2014

BARCELONA, SPAIN — There has been a significant improvement in the one-year mortality rates of elderly individuals admitted to the hospital for acute MI over the past 15 years, and this advance is the result of improved medical therapy and access to PCI, according to the results of a new analysis.

Presenting the results here during European Society of Cardiology 2014 Congress , Dr Etienne Puymirat (European Hospital of Georges Pompidou, Paris, France) said that elderly patients, those aged 75 years of age and older, are typically excluded from clinical trials, so it is not known if the medical benefits accrued over the past 15 years have translated to this population.

Presenting the data, he reported that one-year mortality among acute-MI patients 75 years of age or older has improved from 36% in 1995 to 20% in 2010, a reduction that was observed in STEMI and non-STEMI patients.

"One-year mortality of elderly patients with acute MI has dramatically decreased over the past 15 years," said Puymirat. "This improvement can be explained in our data by the increased use of early PCI, newer anticoagulants, especially low-molecular-weight heparin, and recommended medications."

Four Nationwide French Registries

The analysis included data from four nationwide French registries conducted five years apart starting in 1995. In each, consecutive patients admitted to coronary care units for acute MI over a one-month period were included in the registry. In total, more than 10 500 acute-MI patients were included in the registry analysis. In each of the four registries, approximately 30% of patients were 75 years of age or older.

Over the 15-year period, there was a significant change in the management of acute-MI patients, with 97% of patients treated with antithrombotic medications within 48 hours by 2010. There was also a significant increase in the use of low-molecular-weight heparin and a reduction in the use of unfractionated heparin. Use of statins, ACE inhibitors, ARBs, and beta-blockers also significantly increased.

For the NSTEMI patients, the use of PCI increased from 7% in 1995 to 55% in 2010, with the use of drug-eluting stents increasing from 12% in 2005 to 30% by 2010. The use of PCI within 72 hours after hospital admission also significantly increased, from 4% to 42% from 1995 to 2010. For STEMI patients, the use of primary PCI increased from 5% in 1995 to 58% in 2010. In addition, time delays, including the time from symptom onset to reperfusion, were also significantly reduced over the 15-year period.

In terms of in-hospital complications, an end point that includes recurrent MI, atrial and ventricular fibrillation, stroke, major bleeding, and the need for transfusion, there was a significant reduction from 1995 to 2010. Thirty-day mortality declined from 28% in 1995 to 11% in 2010 in STEMI patients and from 18% to 6% in NSTEMI patients. Overall, the reduction in one-year mortality—from 36% to 20% over the 15 years—was similar in STEMI and NSTEMI patients.

Speaking during the clinical-trials-update session, moderator Dr Luigi Tavazzi (Fondazione IRCCS Policlinico San Matteo, Pavia, Italy) noted that the survival curves separated early, suggesting the reduction in mortality at one year might be the result of in-hospital improvements. Puymirat didn't disagree, noting there have been significant improvements in medication during the acute phase of treatment and that PCI has had an impact, especially on early mortality.

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