gms | German Medical Science

Background: Despite an increase of elderly patients with acute myocardial infarction (AMI) in the developed countries, less is known about short-term outcomes of treatment strategies in combination with adjunctive medications used in elderly AMI patients after the widespread implementation of percutaneous coronary intervention (PCI) therapy. The aim of this study was firstly to assess the association between invasive treatment strategy (PCI and/or coronary artery bypass grafting [CABG]) versus conservative treatment (thrombolysis or no reperfusion therapy) and 28-day-case fatality among AMI patients aged 75-84 years. Secondly, to determine the association between adjunctive medications (beta-blockers, angiotensin-converting-enzyme inhibitors or angiotensin receptor blockers [ACEIs/ARBs], statins, calcium channel blockers [CCBs] and nitrates) and 28-day-case fatality in elderly AMI patients receiving either an invasive or a conservative treatment strategy.

Materials and Methods: From the population-based MONICA/KORA MI registry, 1,223 patients, aged 75–84 years, consecutively hospitalized with an AMI between 2009 and 2012 were included. Data were collected by standardized interviews and chart review. All-cause mortality was assessed on a regular basis and death certificates were obtained from local health departments. Multivariable logistic regression analyses were conducted for all patients with complete data on any of the relevant covariables (n=1,191) and stratified by treatment strategy (invasive vs. conservative).

Results: Of the 1,223 elderlies, 166 (13.6%) patients died within the 28 days of AMI. Overall, 61.5% were treated invasively of which 613 (50.1%) patients received a PCI, 120 (9.8%) received a CABG and 19 patients (1.6%) were treated with both PCI and CABG. The conservative strategy group included 470 (38.4%) patients without any reperfusion therapy and only one person who received thrombolysis in the acute setting. The invasive strategy group was younger, more likely to be of male gender, had more frequently a ST-segment elevation MI, and received more frequently adjunctive drug treatment with beta-blockers, ACEIs/ARBs, statins, antithrombotic agents, nitrates, CCBs, catecholamines, and antiarrhythmics. In the multivariable analysis after adjustment for various confounding variables including guideline-recommended medications (e.g. beta-blockers, ACEIs/ARBs) the odds ratio (OR) for 28-day-case fatality in patients treated with invasive versus conservative strategy was 0.43 (95 % CI 0.27–0.69). The stratified analyses revealed an OR of 0.20 (95 % CI 0.09–0.44) and 0.34 (95 % CI 0.18–0.65) for ACEIs/ARBs treatment in the invasive and conservative strategy, respectively. In patients treated conservatively there were significant associations with beta-blockers (OR 0.39; 95% CI 0.17–0.89) and CCBs (OR 0.42; 95% CI 0.21–0.87) and a positive trend for statin use (OR 0.63; 95% CI 0.33–1.21).

Conclusion: In real-life patient care we observed that invasive treatment strategy compared with conservative treatment showed a strongly inverse relationship with 28-day-case-fatality in elderly AMI patients aged 75-84 years. Beside reperfusion therapy, use of ACEIs/ARBs was independently associated with short-term survival regardless of treatment strategy. Moreover, patients who were not eligible for PCI or CABG might benefit from beta-blockers, CCBs, and statin treatment.