open access

Vol 5, No 3 (2020)
Original article
Published online: 2020-06-05
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Advanced age, time to treatment and long-term mortality: single centre data from the FAST-STEMI network

Monica Verdoia1, Orazio Viola1, Giuseppina D’Amico1, Cinzia Ravetto1, Antonella Comoglio1, Massimo Fusco1, Paolo Giachino1, Sara La Cognata1, Francesca Novara1, Filippo Bristot1, Pierpaolo Pipan1, Morris Magnaghi1, Pier Luigi Solda1, Marta Brancati1, Marco Marcolongo1
·
Medical Research Journal 2020;5(3):135-140.
Affiliations
  1. Cardiologia e Unità Coronarica, Ospedale degli Infermi, ASL Biella, Italy

open access

Vol 5, No 3 (2020)
ORIGINAL ARTICLES
Published online: 2020-06-05

Abstract

Background. Optimization of the techniques and larger accessibility to mechanical reperfusion have significantly improved the outcomes of patients with ST-segment elevation myocardial infarction (STEMI). However, suboptimal results have been observed in certain higher-risk subsets of patients, as in advanced age, where the benefits of primary PCI are more debated. We evaluated the impact of systematic primary percutaneous coronary intervention (PCI) and an optimized STEMI network on the long-term prognosis from a single centre experience.

Methods. We included STEMI patients included in the FAST-STEMI network between 2016 and 2019. Ischemia duration was defined as the time from symptoms onset to coronary reopening (pain-to-balloon, PTB). The primary study endpoint (PE) was a composite of mortality and recurrent MI at long-term follow-up. Indywidual outcome endpoints were also assessed.

Results. We included 253 patients undergoing primary PCI and discharged alive. Mean age was 67.2 ± 12.5 years, 75.1% males and 19.8% diabetics. At a median follow-up of 581 [307–922] days, the primary endpoint occurred in 24 patients (7.9%), of whom 5.5% died. The occurrence of a cardiovascular event was significantly associated with advanced age (p < 0.001), renal failure (p = 0.03), lower ejection fraction at discharge (p = 0.04) and longer in-hospital stay (p = 0.01). The median PTB was 198 minutes [IQR: 125–340 min], that was significantly longer among patients experiencing the PE (p = 0.01). A linear relationship was observed between age and PTB (r = 0.13, p = 0.009). However, both age ≥ 75 years and PTB above the median emerged as independent predictors of the primary endpoint (age: HR [95%CI] = 5.56 [2.26–13.7], p < 0.001, PTB: HR [95%CI] = 3.59 [1.39–9.3], p = 0.01). Similar results were observed for overall mortality.

Conclusion. The present study shows that among STEMI patients undergoing primary PCI in a single centre, the duration of ischemia and advance age are independently associated to long-term mortality and recurrent myocardial infarction. However, longer time to reperfusion was observed among elderly patients.

Abstract

Background. Optimization of the techniques and larger accessibility to mechanical reperfusion have significantly improved the outcomes of patients with ST-segment elevation myocardial infarction (STEMI). However, suboptimal results have been observed in certain higher-risk subsets of patients, as in advanced age, where the benefits of primary PCI are more debated. We evaluated the impact of systematic primary percutaneous coronary intervention (PCI) and an optimized STEMI network on the long-term prognosis from a single centre experience.

Methods. We included STEMI patients included in the FAST-STEMI network between 2016 and 2019. Ischemia duration was defined as the time from symptoms onset to coronary reopening (pain-to-balloon, PTB). The primary study endpoint (PE) was a composite of mortality and recurrent MI at long-term follow-up. Indywidual outcome endpoints were also assessed.

Results. We included 253 patients undergoing primary PCI and discharged alive. Mean age was 67.2 ± 12.5 years, 75.1% males and 19.8% diabetics. At a median follow-up of 581 [307–922] days, the primary endpoint occurred in 24 patients (7.9%), of whom 5.5% died. The occurrence of a cardiovascular event was significantly associated with advanced age (p < 0.001), renal failure (p = 0.03), lower ejection fraction at discharge (p = 0.04) and longer in-hospital stay (p = 0.01). The median PTB was 198 minutes [IQR: 125–340 min], that was significantly longer among patients experiencing the PE (p = 0.01). A linear relationship was observed between age and PTB (r = 0.13, p = 0.009). However, both age ≥ 75 years and PTB above the median emerged as independent predictors of the primary endpoint (age: HR [95%CI] = 5.56 [2.26–13.7], p < 0.001, PTB: HR [95%CI] = 3.59 [1.39–9.3], p = 0.01). Similar results were observed for overall mortality.

Conclusion. The present study shows that among STEMI patients undergoing primary PCI in a single centre, the duration of ischemia and advance age are independently associated to long-term mortality and recurrent myocardial infarction. However, longer time to reperfusion was observed among elderly patients.

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Keywords

ST-segment elevation myocardial infarction, primary percutaneous coronary intervention, hospital facility; ischemia time, outcome

About this article
Title

Advanced age, time to treatment and long-term mortality: single centre data from the FAST-STEMI network

Journal

Medical Research Journal

Issue

Vol 5, No 3 (2020)

Article type

Original article

Pages

135-140

Published online

2020-06-05

Page views

601

Article views/downloads

631

DOI

10.5603/MRJ.a2020.0015

Bibliographic record

Medical Research Journal 2020;5(3):135-140.

Keywords

ST-segment elevation myocardial infarction
primary percutaneous coronary intervention
hospital facility
ischemia time
outcome

Authors

Monica Verdoia
Orazio Viola
Giuseppina D’Amico
Cinzia Ravetto
Antonella Comoglio
Massimo Fusco
Paolo Giachino
Sara La Cognata
Francesca Novara
Filippo Bristot
Pierpaolo Pipan
Morris Magnaghi
Pier Luigi Solda
Marta Brancati
Marco Marcolongo

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