Author + information
- Ajar Kochar,
- Anita Chen,
- Puza Sharma,
- Neha Pagidipati,
- Patricia Cowper,
- Gregg Fonarow,
- Eric Peterson and
- Tracy Wang
Background: Little is known about the long-term survival of older patients with myocardial infarction (MI) treated in routine community practice.
Methods: CRUSADE was a registry of acute coronary syndrome patients treated at 514 US hospitals from 2001 to 2006. We linked STEMI and NSTEMI patients ≥ age 65 in CRUSADE to their Medicare data to ascertain 10-year mortality. A landmark analysis examined 10-year mortality conditioned on surviving the first year post-MI.
Results: Among 22,295 MI patients ≥ age 65, mortality was 24% at 1 year, 51% at 5 years, and 72% at 10 years. Limited to patients aged 65-74, 10-year mortality post-MI remained high at 53%. Long-term mortality was high despite prevalent evidence-based medication use at discharge: aspirin 95%, beta-blockers 94%, and statins 81%. Ten-year mortality was higher among NSTEMI than STEMI patients (73% vs 60%, p<0.001); this difference was attenuated after adjustment (HR 0.93, 95% CI 0.87-0.99). Patients treated with PCI (57%, adj HR 0.65, 95% CI 0.62-0.68) or CABG (57%, adj HR 0.61, 95% CI 0.57-0.66) at index event had lower 10-year mortality compared with medical management (84%). In the landmark analysis, 10-year mortality was 63% among patients who survived the first year post-MI.
Conclusions: We observed high 10-year mortality for MI patients in community practice, even among patients aged 65-74, revascularized patients, and those who survived the first year. These results suggest treatment opportunities to improve long term post-MI mortality.
Room 150 A
Sunday, March 19, 2017, 9:04 a.m.-9:14 a.m.
Session Title: Highlighted Original Research: Acute and Stable Ischemic Heart Disease and the Year in Review
Abstract Category: 2. Acute and Stable Ischemic Heart Disease: Clinical
Presentation Number: 907-12
- 2017 American College of Cardiology Foundation