Comparison of clinical outcomes between octogenarians and non-octogenarians with acute myocardial infarction in the drug-eluting stent era: Analysis of the Korean Acute Myocardial Infarction Registry

Abstract

Background and purpose. Octogenarians (age ≥ 80 years) with coronary artery disease constitute a high-risk group. However, octogenarian patients with acute myocardial infarction (AMI) in the drug-eluting stents (DES) era have not been widely reported. We aimed to identify clinical outcomes in octogenarian compared with non-octogenarian AMI patients.

Methods and subjects. We retrospectively analyzed 9877 patients who underwent percutaneous coronary intervention (PCI) with drug-eluting stents (DES) and who were enrolled in the Korean Acute Myocardial Infarction Registry (KAMIR). They were divided into 2 groups, octogenarians (n = 1494) and non-octogenarians (n = 8383), in order to compare the incidence of 1-year all-cause death and 1-year major adverse cardiac events (MACE), where MACE included all-cause death, recurrent myocardial infarction, target vessel revascularization (TVR), target lesion revascularization (TLR), and coronary artery bypass grafting (CABG).

Results. The clinical status was significantly inferior in octogenarians compared to non-octogenarians: Killip class ≥ II (34.8% vs. 22.5%, p < 0.001), multivessel disease (65.8% vs. 53.7%, p < 0.001). Rates of 1-year all-cause death were significantly higher in octogenarians than in non-octogenarians (22.3% vs. 6.5%, p < 0.001). However, the rates of 1-year recurrent myocardial infarction (1.3% vs. 0.9%, p = 0.68), TLR (2.4% vs. 3.1%, p = 0.69), TVR (3.6% vs. 4.3%, p = 0.96), and CABG (0.9% vs. 0.9%, p = 0.76) did not differ significantly between the 2 groups.

Conclusions. Octogenarian AMI patients have higher rates of mortality and MACE even in the DES era. According to KAMIR subgroup analysis, the TLR/TVR rates in octogenarians were comparable to those in non-octogenarian AMI patients.