The Impact of Advanced Age on Major Cardiovascular Events and Mortality in Patients with ST-Elevation Myocardial Infarction Undergoing a Pharmaco-Invasive Strategy

Izo Helber,1 Claudia Maria Rodrigues Alves,1 Stela Maris Grespan,1 Eduardo CA Veiga,2 Pedro IM Moraes,1 José Marconi Souza,1 Adriano H Barbosa,1 Iran Gonçalves Jr,1 Francisco AH Fonseca,1 Antônio Carlos C Carvalho1,†, Adriano Caixeta1,3 1Department of Medicine, Discipline of Cardiology, Escola Paulista de Medicina, Universidade Federal São Paulo, São Paulo, Brazil; 2Department of Gynecology and Obstetrics, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; 3Department of Cardiology, Hospital Israelita Albert Einstein, São Paulo, Brazil†Dr Antonio Carlos De Camargo Carvalho passed away on January 8, 2019Correspondence: Adriano CaixetaEscola Paulista de Medicina, Universidade Federal São Paulo, Av. Napoleão de Barros, 715, São Paulo, CEP: 04024002, BrazilTel +55 11- 5576-4000Email adriano.caixeta@einstein.br Twitter @adrianocaixetaBackground: There is little research in the efficacy and safety of a pharmaco-invasive strategy (PIS) in patients ≥ 75 years versus < 75 years of age. We aimed to evaluate and compare the influence of advanced age on the risk of death and major adverse cardiac events (MACE) in patients undergoing PIS.Methods: Between January 2010 and November 2016, 14 municipal emergency rooms in São Paulo, Brazil, used full-dose tenecteplase to treat patients with STEMI as part of a pharmaco-invasive strategy for a local network implementation.Results: A total of 1852 patients undergoing PIS were evaluated, of which 160 (9%) were ≥ 75 years of age. Compared to patients < 75 years, those ≥ 75 years were more often female, had lower body mass index, higher rates of hypertension; higher incidence of hypothyroidism, chronic renal failure, prior stroke, and diabetes. Compared to patients < 75 years of age, in-hospital MACE and mortality were higher in patients with ≥ 75 years (6.5% versus 19.4%; p< 0.001; and 4.0% versus 18.2%; p< 0.001, respectively). Patients ≥ 75 years had higher rates of in-hospital major bleeding (2.7% versus 5.6%; p=0.04) and higher incidence of cardiogenic shock (7.0% versus 19.6%; p< 0.001). By multivariable analysis, age ≥ 75 years was independent predictor of MACE (OR 3.57, 95% CI 1.72 to 7.42, p=0.001) and death (OR 2.07, 95% CI 1.12– 3.82, p=0.020).Conclusion: In patients with ST-segment elevation myocardial infarction undergoing PIS, age ≥ 75 years was an independent factor that entailed a 3.5-fold higher MACE and 2-fold higher mortality rate compared to patients < 75 years of age.Keywords: acute myocardial infarction, elderly, fibrinolysis, primary percutaneous coronary intervention, pharmaco-invasive strategy