Older patients with acute MI less likely to receive PCI
Patients older than 65 years with acute MI were less likely to have PCI while receiving other therapeutic approaches, according to findings presented during the American Heart Association Quality of Care and Outcomes Research Scientific Sessions.
Wojciech Rzechorzek, MD, and colleagues examined outcomes and therapeutic approaches in a large unselected population of patients.
“Our study found that seniors were less likely to undergo PCI for a heart attack and if they do receive the procedure it’s not within the optimal time for the best possible outcome, Rzechorzek, a resident at Mount Sinai St. Luke’s and Mount Sinai West Hospital, said in a press release. “Their prognosis is worse than for younger patients with the same conditions, and this lack of treatment or delay in treatment could be a factor.”
Rzechorzek and colleagues analyzed data from the 2014 Nationwide Inpatient Sample of 115,042 patients with acute MI.
Fifty-four percent of patients were older than 65 years.
The cohort older than 65 years of age had more women compared with patients 65 years or younger (45% vs 30%, P < .001), Rzechorzek and colleagues wrote in an abstract.
Patients older than 65 years were more likely to have chronic kidney disease (26% vs 9%, P < .001) and hypertension (78% vs 69%, P < .001) compared with younger patients, the researchers wrote. The likeliness for HF (0.8% vs 0.5%, P < .001) and diabetes (32% vs 29%; P < .001) was also higher in patients older than 65 years.
Patients 65 years or older were less likely to receive PCI including angioplasty (OR = 0.66; 95% C, 0.46-0.94) and stent placement (OR = 0.64; 95% CI, 0.62-0.67); Rzechorzek and colleagues wrote. Patients older than 65 also had less timely stent implantation (OR for stent within 48 hours = 0.66; 95% CI, 0.63-0.68).
Patients older than 65 years of age with acute MI had a higher incidence of cardiac arrest (OR = 1.21, 95% CI, 1.06-1.37) and higher in-hospital mortality (OR = 2.32; 95% CI, 2.11-2.56) compared with younger, the researchers wrote.
Older patients were more likely to have shock (OR = 1.28; 95% CI, 1.06-1.54) and HF (OR = 1.62; 95% CI, 1.54-1.71) compared with younger patients. Patients older than 65 were also more likely to require mechanical ventilation (OR = 1.15; 95% CI, 1.07-1.25).
Rzechorzek and colleagues wrote patients older than 65 had lower hospital charges (Coefficient = –$3,231; 95% CI = –5,237 to –1,224; P = .002) despite having a longer hospital stay (Coefficient = 0.56; 95% CI, 0.45–0.66; P < .001).
“I am surprised that the costs of stay are lower despite the increased length of stay, but this could be primarily driven by decreased use of PCI, which is an expensive procedure,” Rzechorzek said in the release. – by Earl Holland Jr.
Rzechorzek W, et al. Poster 270. Presented at: AHA Quality of Care and Outcomes Research Scientific Sessions; April 5-6, 2019; Arlington, Va.
Disclosures: The authors report no relevant financial disclosures.