Underuse of coronary intervention and its impact on mortality in the elderly with myocardial infarction. A propensity-matched analysis from the Hungarian Myocardial Infarction Registry

A. Komócsi, Mihály Simon, B. Merkely, Tibor Szuk, R. Kiss, D. Aradi, Zoltán Ruzsa, Péter Andrássy, Lajos Nagy, Géza Lupkovics, Zsolt Koszegi, Péter Ofner, A. Jánosi

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background Data are limited on the real-life use of coronary intervention (PCI) and on its long-term efficacy and safety in elderly patients with acute myocardial infarction (AMI). Methods Data from a nation-wide registry of patients treated due to an AMI event in centers of invasive cardiology were analyzed for the potential interaction of age on the utilization of invasive therapy and outcome. Follow-up data of consecutive patients between March 1, 2013, and March 1, 2014 were analyzed. Differences in the risk of all-cause death at 1 year between patients undergoing PCI versus others receiving conservative treatment were determined from vital records and were compared with propensity score matching. Results A total of 8485 consecutive patients were enrolled at 19 centers. Sixty-three percent of the patients were male; the mean age was 65.1 ± 12.4 years. The proportion of STEMI cases was 51%. STEMI cases were treated with primary PCI in 91.0% while patients with NSTEACS underwent PCI in 71.0%. The age of patients was a significant determinant of deferring coronary angiography (Hazard ratio (HR): 0.524 95% confidence interval (CI) 0.47-0.59, p <0.001) and PCI (HR: 0.76 95% CI 0.73-0.80, p <0.001). One-year survival after PCI was significantly better both in the overall and in the propensity matched cohort (HR: 0.44 [95% CI: 0.39-0.49] and HR: 0.59 [95% CI: 0.50-0.69], p <0.001, both). This benefit remained consistent in age-dependent subgroup analyses. Conclusion Coronary intervention is underused among the elderly despite the mortality benefit of interventional therapy in myocardial infarction that is consistent in all age groups.

Original languageEnglish
Pages (from-to)485-490
Number of pages6
JournalInternational Journal of Cardiology
Volume214
DOIs
Publication statusPublished - Jul 1 2016

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Registries
Myocardial Infarction
Mortality
Confidence Intervals
Propensity Score
Cardiology
Coronary Angiography
Cause of Death
Age Groups
Safety
Survival
Therapeutics

Keywords

  • Acute coronary syndromes
  • Elderly
  • Mortality
  • Percutaneous coronary intervention

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Underuse of coronary intervention and its impact on mortality in the elderly with myocardial infarction. A propensity-matched analysis from the Hungarian Myocardial Infarction Registry. / Komócsi, A.; Simon, Mihály; Merkely, B.; Szuk, Tibor; Kiss, R.; Aradi, D.; Ruzsa, Zoltán; Andrássy, Péter; Nagy, Lajos; Lupkovics, Géza; Koszegi, Zsolt; Ofner, Péter; Jánosi, A.

In: International Journal of Cardiology, Vol. 214, 01.07.2016, p. 485-490.

Research output: Contribution to journalArticle

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title = "Underuse of coronary intervention and its impact on mortality in the elderly with myocardial infarction. A propensity-matched analysis from the Hungarian Myocardial Infarction Registry",
abstract = "Background Data are limited on the real-life use of coronary intervention (PCI) and on its long-term efficacy and safety in elderly patients with acute myocardial infarction (AMI). Methods Data from a nation-wide registry of patients treated due to an AMI event in centers of invasive cardiology were analyzed for the potential interaction of age on the utilization of invasive therapy and outcome. Follow-up data of consecutive patients between March 1, 2013, and March 1, 2014 were analyzed. Differences in the risk of all-cause death at 1 year between patients undergoing PCI versus others receiving conservative treatment were determined from vital records and were compared with propensity score matching. Results A total of 8485 consecutive patients were enrolled at 19 centers. Sixty-three percent of the patients were male; the mean age was 65.1 ± 12.4 years. The proportion of STEMI cases was 51{\%}. STEMI cases were treated with primary PCI in 91.0{\%} while patients with NSTEACS underwent PCI in 71.0{\%}. The age of patients was a significant determinant of deferring coronary angiography (Hazard ratio (HR): 0.524 95{\%} confidence interval (CI) 0.47-0.59, p <0.001) and PCI (HR: 0.76 95{\%} CI 0.73-0.80, p <0.001). One-year survival after PCI was significantly better both in the overall and in the propensity matched cohort (HR: 0.44 [95{\%} CI: 0.39-0.49] and HR: 0.59 [95{\%} CI: 0.50-0.69], p <0.001, both). This benefit remained consistent in age-dependent subgroup analyses. Conclusion Coronary intervention is underused among the elderly despite the mortality benefit of interventional therapy in myocardial infarction that is consistent in all age groups.",
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author = "A. Kom{\'o}csi and Mih{\'a}ly Simon and B. Merkely and Tibor Szuk and R. Kiss and D. Aradi and Zolt{\'a}n Ruzsa and P{\'e}ter Andr{\'a}ssy and Lajos Nagy and G{\'e}za Lupkovics and Zsolt Koszegi and P{\'e}ter Ofner and A. J{\'a}nosi",
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T1 - Underuse of coronary intervention and its impact on mortality in the elderly with myocardial infarction. A propensity-matched analysis from the Hungarian Myocardial Infarction Registry

AU - Komócsi, A.

AU - Simon, Mihály

AU - Merkely, B.

AU - Szuk, Tibor

AU - Kiss, R.

AU - Aradi, D.

AU - Ruzsa, Zoltán

AU - Andrássy, Péter

AU - Nagy, Lajos

AU - Lupkovics, Géza

AU - Koszegi, Zsolt

AU - Ofner, Péter

AU - Jánosi, A.

PY - 2016/7/1

Y1 - 2016/7/1

N2 - Background Data are limited on the real-life use of coronary intervention (PCI) and on its long-term efficacy and safety in elderly patients with acute myocardial infarction (AMI). Methods Data from a nation-wide registry of patients treated due to an AMI event in centers of invasive cardiology were analyzed for the potential interaction of age on the utilization of invasive therapy and outcome. Follow-up data of consecutive patients between March 1, 2013, and March 1, 2014 were analyzed. Differences in the risk of all-cause death at 1 year between patients undergoing PCI versus others receiving conservative treatment were determined from vital records and were compared with propensity score matching. Results A total of 8485 consecutive patients were enrolled at 19 centers. Sixty-three percent of the patients were male; the mean age was 65.1 ± 12.4 years. The proportion of STEMI cases was 51%. STEMI cases were treated with primary PCI in 91.0% while patients with NSTEACS underwent PCI in 71.0%. The age of patients was a significant determinant of deferring coronary angiography (Hazard ratio (HR): 0.524 95% confidence interval (CI) 0.47-0.59, p <0.001) and PCI (HR: 0.76 95% CI 0.73-0.80, p <0.001). One-year survival after PCI was significantly better both in the overall and in the propensity matched cohort (HR: 0.44 [95% CI: 0.39-0.49] and HR: 0.59 [95% CI: 0.50-0.69], p <0.001, both). This benefit remained consistent in age-dependent subgroup analyses. Conclusion Coronary intervention is underused among the elderly despite the mortality benefit of interventional therapy in myocardial infarction that is consistent in all age groups.

AB - Background Data are limited on the real-life use of coronary intervention (PCI) and on its long-term efficacy and safety in elderly patients with acute myocardial infarction (AMI). Methods Data from a nation-wide registry of patients treated due to an AMI event in centers of invasive cardiology were analyzed for the potential interaction of age on the utilization of invasive therapy and outcome. Follow-up data of consecutive patients between March 1, 2013, and March 1, 2014 were analyzed. Differences in the risk of all-cause death at 1 year between patients undergoing PCI versus others receiving conservative treatment were determined from vital records and were compared with propensity score matching. Results A total of 8485 consecutive patients were enrolled at 19 centers. Sixty-three percent of the patients were male; the mean age was 65.1 ± 12.4 years. The proportion of STEMI cases was 51%. STEMI cases were treated with primary PCI in 91.0% while patients with NSTEACS underwent PCI in 71.0%. The age of patients was a significant determinant of deferring coronary angiography (Hazard ratio (HR): 0.524 95% confidence interval (CI) 0.47-0.59, p <0.001) and PCI (HR: 0.76 95% CI 0.73-0.80, p <0.001). One-year survival after PCI was significantly better both in the overall and in the propensity matched cohort (HR: 0.44 [95% CI: 0.39-0.49] and HR: 0.59 [95% CI: 0.50-0.69], p <0.001, both). This benefit remained consistent in age-dependent subgroup analyses. Conclusion Coronary intervention is underused among the elderly despite the mortality benefit of interventional therapy in myocardial infarction that is consistent in all age groups.

KW - Acute coronary syndromes

KW - Elderly

KW - Mortality

KW - Percutaneous coronary intervention

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