Objective

The main aim of the study is to study the influence of age on the clinical outcomes in STEMI patients undergoing primary PCI or fibrinolytic therapy. Also, it assessed the angiographic profile of STEMI patients and compared the outcomes of primary PCI vs. fibrinolytic therapy in STEMI patients aged >65 years.

Methods

This is a prospective observational study which analysed the clinical profile of 500 consecutive patients with STEMI undergoing primary PCI or thrombolysis at the Department of Cardiology, Government Medical College, Kottayam, Kerala, India from August 2011 to September 2012. The primary endpoint of the study is major adverse cardiovascular events (MACE) at the end of hospitalization. MACE comprises of recurrent angina, re–infarction, heart failure, arrhythmia and death. Secondary end–points comprises of safety outcomes like major bleeding and disabling stroke

Results

Patients were categorized into four groups depending on the age (<55 years, 55–65 years, 66–75 years and >75 year). The incidence of triple vessel disease (TVD) and tortuous calcified coronaries were more in those aged more than 65 years.In–hospital and one–year outcomes including death, re–infarction, stroke and major bleeding were compared in different age groups. In–hospital re–infarction rate was comparable between the two groups aged <65 years and >65 years. But, there was significant difference between two groups in terms of mortality (4.30 vs. 9.80, p=0.03).There was no statistical difference in the incidence of major bleed between different age groups. In all age–groups thrombolyzed patients had a higher mortality compared to PCI (p=0.04).

Conclusion

The clinical outcomes of acute STEMI was more adverse in patients aged more than 65 years compared to those aged less than 65 years in terms of mortality, recurrent ischemia, re–infarction and stroke irrespective of the mode of reperfusion therapy. Additionally, primary PCI was superior to fibrinolysis in reducing death, reinfarction and disabling stroke in older patients with STEMI aged more than 65 years.