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Background: Older adults (≥ 75 years) carry an increased risk of mortality after STEMI complicated by cardiogenic shock. Outcomes of PCI after STEMI and shock in older adults remain largely unknown.
Methods: We utilized the AHRQ NIS (2003–2013) to estimate temporal trends of PCI and clinical outcomes among older adults presenting with STEMI and shock.
Results: Of the 230,146 patients with STEMI and shock in the United States, 76,905 (33%) were adults 75 years or older. Of these, 52% were females and 83% were Caucasians. The median [IQR] number of chronic medical conditions were 8 [6, 10]. The number of older adults presenting with STEMI and shock decreased overtime (2003: 36% vs. 2013: 29%). Concomitantly, the rate of PCI utilization increased (2003: 35% vs 2013: 56%, p <0.001), with declining death rates (2003: 60% vs. 2013: 46%, p <0.001). PCI was associated with a lower risk of mortality (Unadjusted OR: 0.47, Cl 0.45–0.71, p <0.001). After adjustment for potential confounders including number of chronic medical conditions, PCI remained associated with a lower risk of in-hospital mortality (Adjusted OR: 0.51, CI 0.46–0.57, p< 0.001).
Conclusions: Although older adults with STEMI and cardiogenic shock have been systematically excluded from clinical trials, this “real world” analysis shows that PCI rates have been increasing progressively. This increase in PCI rates has been associated with a progressive reduction of in-hospital mortality, thus indirectly supporting a benefit of coronary revascularization.
Poster Hall, Hall C
Friday, March 17, 2017, 3:45 p.m.-4:30 p.m.
Session Title: PCI for NSTEMI and Complex Patients With Multiple Co-Morbidities
Abstract Category: 19. Interventional Cardiology: Complex Patients/Comorbidities
Presentation Number: 1154-144
- 2017 American College of Cardiology Foundation