Temporal trends in revascularization and outcomes after acute myocardial infarction among the very elderly

Abstract

Background: Few data are available on time-related changes in use and outcomes of invasive procedures after acute myocardial infarction in very elderly patients. Our objective was to describe trends in revascularization procedures and outcomes in a provincial cohort of very elderly patients who had experienced acute myocardial infarction.

Methods: We used a database of hospital discharge summaries to identify all patients aged 80 years or older admitted for acute myocardial infarction in Quebec. We used the provincial database of physicians' services and medication claims to assess treatment and obtain data on survival.

Results: Between March 1996 and March 2007, 29 750 patients aged 80 years or older were admitted to hospital for acute myocardial infarction. During this period, use of percutaneous coronary interventions increased from 2.2% to 24.9%, and use of coronary artery bypass graft surgery increased from 0.8% to 3.1%. Evidence-based prescriptions of medication increased over time (p < 0.001). The prevalence of reported comorbidities was higher during the period of 2003-2006 than during the 1996-1999 period. One-year mortality improved over time (46.5% for 1996-1999 v. 40.9% for 2003-2006, p < 0.001) but remained unchanged in the subgroup of patients who did not undergo revascularization.

Interpretation: The use of revascularization, especially percutaneous coronary interventions, in the very elderly after acute myocardial infarction has been growing at a rapid pace, while the prevalence of reported comorbidities has been increasing in this population. Revascularization procedures are no longer restricted to younger patients. In the context of an aging population, it is imperative to determine whether these changes in practice are cost-effective.

Figure 1

Temporal trends in procedure use after acute myocardial infarction in patients aged 80 years or older. Note: PCI 30d = percutaneous coronary intervention performed within 30 days after acute myocardial infarction (including PCI1d); CABG 90d = coronary artery bypass graft surgery performed within 90 days after acute myocardial infarction; PCI 1d = percutaneous coronary intervention performed within the first 24 hours after hospital admission; CATH 30d = coronary angiogram performed within 30 days after acute myocardial infarction; No revascularization = no CABG within 90 days nor percutaneous coronary intervention within 30 days after acute myocardial infarction.

Figure 2

Temporal trends in one-year mortality after acute myocardial infarction among patients aged 80 years or older. Note: AMI = all patients with acute myocardial infarction; CABG 90d = coronary artery bypass graft surgery performed within 90 days of acute myocardial infarction; PCI 30d = percutaneous coronary intervention performed within 30 days after acute myocardial infarction (including PCI1d); PCI 1d = percutaneous coronary intervention performed within the first 24 hours after hospital admission; No revascularization = no CABG within 90 days nor percutaneous coronary intervention within 30 days after acute myocardial infarction.