Impact of Age at the Time of the First ST-Elevation Myocardial Infarction on 10-Year Outcomes (from the EXAMINATION-EXTEND Trial) - 02/02/23

Doi : 10.1016/j.amjcard.2022.11.035

Victor Arévalos, MD ^a, Francesco Spione, MD ^a,^b, Rami Gabani, MD ^a, Luis Ortega-Paz, MD, PhD ^a,^c, Josep Gómez-Lara, MD, PhD ^d, Víctor Jiménez-Díaz, MD, PhD ^e,^f, Marcelo Jiménez, MD ^g, Pilar Jiménez-Quevedo, MD, PhD ^h, Roberto Diletti, MD, PhD ⁱ, Javier Pineda, MD, PhD ^j, Gianluca Campo, MD, PhD ^k, Antonio Silvestro, MD ^l, Jaume Maristany, MD, PhD ^m, Xacobe Flores, MD, PhD ⁿ, Loreto Oyarzabal, MD ^d, Guillermo Bastos-Fernandez, MD ^e,^f, Andrés Iñiguez, MD, PhD ^e,^f, Antonio Serra, MD, PhD ^g, Javier Escaned, MD, PhD ^h, Alfonso Ielasi, MD, PhD ^l, Maurizio Tespili, MD, PhD ^l, Mattie Lenzen, MD, PhD ⁱ, Antonio Fernández-Ortiz, MD, PhD ^h, Pascual Bordes, MD ^j, Matteo Tebaldi, MD ^k, Simone Biscaglia, MD ^k, Soheil Al-Shaibani, MD ⁱ, Rafael Romaguera, MD ^d, Joan Antoni Gómez-Hospital, MD, PhD ^d, Josep Rodes-Cabau, MD, PhD ^a, Patrick W. Serruys, MD, PhD ^o,^p, Manel Sabaté, MD, PhD ^a,^q, Salvatore Brugaletta, MD, PhD ^a,^⁎
^a Hospital Clínic, Cardiovascular Clinic Institute, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
^b Department of Advanced Biomedical Sciences – University of Naples, Federico II, Italy
^c Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida
^d Hospital Universitari de Bellvitge, Institut d'Investigació Biomedica de Bellvitge, L'Hospitalet de Llobregat, Spain
^e Hospital Alvaro Cunqueiro, Vigo, Spain
^f Cardiovascular Research Group, Galicia sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO
^g Deparment of Cardiology, University Hospital of Sant Pau, Barcelona, Spain
^h Department of Cardiology, University Hospital San Carlos, Madrid, Spain
ⁱ Thoraxcenter, Rotterdam, and Netherlands
^j Hospital General of Alicante, Alicante, Spain
^k Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Cona, Italy
^l Deparment of Cardiology, University Hospital Bolognini Seriate, Bergamo; Italy
^m Hospital Son Dureta, Palma de Mallorca, Spain
ⁿ Hospital Universitario, A Coruña, Spain
^o International Center of Circulatory Health, Imperial College London, London, United Kingdom
^p Department of Cardiology, National University of Ireland, Galway, Galway, Ireland
^q CIBER-CV, Instituto de Salud Carlos III, Spain

^⁎Corresponding author: Tel: +34 932279305; fax: +34 93227930.

Résumé

The aim of this substudy of the EXAMINATION-EXTEND was to analyze 10-year outcomes according to the patient's age at the time of the first ST-elevation myocardial infarction (STEMI). Of 1,498 patients with STEMI included in the EXAMINATION-EXTEND study, those with a previous history of coronary ischemic even or ischemic stroke were excluded from this analysis. The remaining 1,375 patients were divided into 4 age groups: <55, 55 to 65, 65 to 75, and >75 years. The primary end point was 10-year patient-oriented composite end point (POCE) of all-cause death, any MI, or any revascularization. At 10-year follow-up, patients aged <55 years (adjusted hazard ratio [HR] 0.24, 95% confidence interval [CI] 0.18 to 0.31, p = 0.001), 55 to 65 years (adjusted HR 0.26, 95% CI 0.20 to 0.34, p = 0.001), and 65 to 75 years (adjusted HR 0.38, 95% CI 0.30 to 0.50, p = 0.001) showed lower risk of POCE than those aged >75 years, led by a lower incidence of all-cause death (<55 : 6% vs 55 to 65: 11.9% vs 65 to 75: 25.7% vs >75 years: 61.6%, p = 0.001). Cardiac death was more prevalent in the older group (<55: 3.7% vs 55 to 65: 5.8% vs 65 to 75: 10.9% vs >75 years: 35.5%, p = 0.001). In the landmark analyses, between 5- and 10-year follow-up, young patients exhibited a higher incidence of any revascularization (<55: 7.4% vs 55 to 65: 4.9% vs 65 to 75: 1.8% vs >65 years: 1.6%, p = 0.001). In conclusion, in patients with a first STEMI, advanced age was associated with high rates of POCE at 10-year follow-up due to all-cause and cardiac death. Conversely, younger patients exhibited a high risk of revascularization at long-term follow-up.

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Plan

Funding: The EXAMINATION trial was partially funded by an unrestricted grant from Abbott Vascular (Santa Clara, California) to the Spanish Heart Foundation (promoter) during the first 5 years of follow-up. The EXAMINATION-EXTEND study was funded by an unrestricted grant from Abbott Vascular (Santa Clara, California) to the Spanish Heart Foundation (promoter).

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Impact of Age at the Time of the First ST-Elevation Myocardial Infarction on 10-Year Outcomes (from the EXAMINATION-EXTEND Trial) - 02/02/23

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