Changes in One-Year Mortality in Elderly Patients Admitted with Acute Myocardial Infarction in Relation with Early Management - 17/05/17
, Nadia Aissaoui, MD, PhD b, Guillaume Cayla, MD, PhD c, Alexandre Lafont, MD a, Elisabeth Riant, MD a, Marco Mennuni, MD a, d, Olivier Saint-Jean, MD, PhD e, Didier Blanchard, MD f, Patrick Jourdain, MD, PhD g, Meyer Elbaz, MD, PhD h, Patrick Henry, MD, PhD i, Vincent Bataille, PhD j, Elodie Drouet, MSc k, Geneviève Mulak, PharmD l, François Schiele, MD, PhD m, Jean Ferrières, MD, PhD j, Tabassome Simon, MD, PhD k, Nicolas Danchin, MD afor the
FAST-MI investigators
Abstract |
Background |
Elderly patients are underrepresented in acute myocardial infarction trials. Our aim was to determine whether, in elderly patients, changes in management in the past 15 years are associated with improved 1-year mortality after hospital admission for myocardial infarction.
Methods |
We used data from 4 1-month French registries, conducted 5 years apart from 1995 to 2010, including 3389 elderly patients (≥75 years of age).
Results |
From 1995 to 2010, mean age remained stable (82.1 years), similar in ST- and non-ST-elevation myocardial infarction patients. Obesity, diabetes, hypertension, and hypercholesterolemia increased. History of prior myocardial infarction, stroke, and peripheral artery disease remained stable, while history of heart failure decreased. Major changes in management were noted: early percutaneous coronary intervention, early treatment with antiplatelet agents, low-molecular-weight heparin, beta-blockers, angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, and statins all increased. Early mortality after hospital admission decreased from 25.0% to 8.4%. One-year mortality decreased from 36.2% to 20.0% (adjusted hazard ratio 2010 vs 1995: 0.47, 0.39-0.57), both for ST-elevation myocardial infarction (36.8% to 21.1%) and non-ST-elevation myocardial infarction (34.8% to 19.1%). Mortality reduction was observed in all age groups, including those ≥85 years of age (from 46.2% to 31.4%). The study period, however, was no longer associated with decreased mortality when variables reflecting management changes were taken into account.
Conclusions |
Early and 1-year mortality after hospital admission of elderly patients with acute myocardial infarction has substantially decreased over the past 15 years. This improvement is likely mediated by increasing use of recommended management strategies. These data support the application of guidelines derived from trials mostly including younger patients to elderly populations as well.
Le texte complet de cet article est disponible en PDF.Keywords : Acute myocardial infarction, Coronary angiography, Elderly, Mortality, Percutaneous coronary intervention
Plan
| Funding: USIK 1995 was funded by Laboratoire Roussel, which was involved in the design and conduct of the study, as well as data collection and management. USIC 2000 was funded by Aventis-France, which was involved in the design and conduct of the study, as well as data collection and management. FAST-MI 2005 and FAST-MI 2010 are registries of the French Society of Cardiology. FAST-MI 2005 was supported by unrestricted grants from Pfizer and Servier, and an additional grant from the Caisse Nationale d'Assurance Maladie-Travailleurs Salariés. FAST-MI 2010 was supported by unrestricted grants from AstraZeneca, the Daiichi-Sankyo-Eli-Lilly alliance, GlaxoSmithKline, Merck, Novartis, and Sanofi-Aventis. None of the companies had a role in the design and conduct of the study, data collection, or management. They were not involved in the analysis and interpretation of the data, nor in the preparation, review, or approval of the manuscript. |
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| Conflict of Interest: EP reported speaker, board membership, and consulting fees: Amgen, AstraZeneca, Bayer, Daiichi Sankyo, Lilly, MSD, Sanofi-Aventis. NA reported speaker fees: Astra Zeneca. GC reported grants to the Institution or Consulting/lecture fees from: Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Boston, Biotronik, BMS, Daiichi Sankyo, Eli-Lilly, Europe, Fédération Française de Cardiologie, Fondation Coeur et recherche, Medtronick, MSD, Pfizer, Sanofi-Aventis, The Medicines Company. DB reported lectures and consulting fees for Edwards LifeSciences. ME reported research grants to the Institution from Boston Inc or Symposia and consulting fees from Bayer, Jansen Cilag, Bristol-Myers-Squibb, Pfizer, AstraZeneca, Daiichi-Sankyo. PH reported disclosures from Astra-Zeneca and Bayer. FS reported receiving grant support to his institution and travel support for scientific meetings: Amgen, AstraZeneca, Boehringer-Ingelheim, BMS Daiichi–Sankyo, Lilly, Medtronic, Merck, Pfizer, Sanofi Aventis, and Servier. JF reported receiving grants and speaker fees: Amgen, MSD and Sanofi. TS reported institutional grants from AstraZeneca, Daiichi-Sankyo, Eli-Lilly, GSK, MSD, Novartis, and Pfizer; personal fees from board membership, consultancy, or lecture from AstraZeneca, Astellas, Bayer, BMS, Lilly, MSD, and Sanofi. ND reported receiving research grants: AstraZeneca, Daiichi-Sankyo, Eli-Lilly, Glaxo-Smith-Kline, MSD, Novartis, Pfizer, Sanofi Aventis, Servier, and The Medicines Company; and advisory panels or lecture fees: AstraZeneca, Boehringer-Ingelheim, Bristol-Myers Squibb, Eli-Lilly, Menarini, Merck-Serono, Novo-Nordisk, Servier, and Sanofi Aventis. ER, AL, MM, OS-J, PJ, VB, ED, and GM reported no conflicts of interest for the present study. |
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| Authorship: All authors had access to the data and played a role in writing this manuscript. |
Vol 130 - N° 5
P. 555-563 - mai 2017 Retour au numéro
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