REVASCULARIZING ELDERLY PATIENTS WITH ACUTE ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION UNDER 90...
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i2 SUMMIT E1806 JACC April 5, 2011 Volume 57, Issue 14 REVASCULARIZING ELDERLY PATIENTS WITH ACUTE ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION UNDER 90 MINUTES: IS IT ACHIEVABLE? RESULTS FROM THE AURORA ST. LUKE’S 24X7 STEMI PROGRAM i2 Poster Contributions Ernest N. Morial Convention Center, Hall F Sunday, April 03, 2011, 3:30 p.m.-4:45 p.m. Session Title: PCI - Acute MI Abstract Category: 6. PCI - Acute MI Session-Poster Board Number: 2506-564 Authors: M. Fuad Jan, Naoyo Mori, Anjan Gupta, Suhail Allaqaband, Tanvir Bajwa, Aurora Cardiovasc Svcs, Aurora Sinai/St. Luke’s Med Ctrs, Univ Wisconsin Sch Med & Public Health, Milwaukee, WI, Center for Urban Population Health, University of Wisconsin-Milwaukee, Milwaukee, WI Background: Limited data exists on door-to-balloon times (D2B) in elderly patients with acute ST-segment elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (PPCI). We compared D2B between elderly (age ≥75) and younger patients using a novel STEMI protocol. Methods: From April 2004 to June 2009, 611 patients with acute STEMI presented directly to our emergency department and underwent PPCI under the Aurora St. Luke’s 24x7 STEMI Program: a team of an interventional cardiologist, registered nurse and two cardiovascular technologists in-hospital 24 hours a day, 7 days a week. We recorded patients as elderly (≥75 years) or younger (<75 years). Results: Of 611 consecutive STEMI patients, 116 (19.0%) were elderly, (median age 81; median age of younger group: 58). Compared with younger patients, the elderly were more often female (54.3% vs. 24.7%, p<0.001) and hypertensive (72.4% vs. 53.3%, p<0.001). Heart failure (7.8% vs. 1.6%, p<0.001), peripheral artery disease (12.1% vs. 4.0%, p<0.001) and cardiogenic shock (13.6% vs. 7.0%, p=0.030) were also more common in elderly. Elderly had longer D2B (61 vs. 53 min, p=0.009), but D2B < 90 min was still achieved in 86.2% (100 of 116) versus 89.8% (445 of 495) in younger group (p=NS) (Table). Conclusion: Aurora St. Luke’s 24x7 STEMI Program - an important demonstration project in systems improvement - shows it is possible to achieve revascularization within 90 minutes not only in the general STEMI population but also in the elderly. Door-to-Balloon Times by Age Characteristic Younger than 75 75 and older p-Value No. patients (%) 495 (81.0%) 116 (19.0%) Door-to-Balloon Time Median D2B time - min (IQR) 53 (42-71) 61 (48-74) 0.009 <30 min - no. (%) 36 (7.3%) 5 (4.3%) 0.307 30-59 min - no. (%) 267 (53.9%) 51 (44.0%) 0.067 60-89 min - no. (%) 142 (28.7%) 44 (37.9%) 0.067 90-119 min - no. (%) 29 (5.9%) 10 (8.6%) 0.377 120-149 min - no. (%) 11 (2.2%) 2 (1.7%) 1.000 150-179 min - no. (%) 3 (0.6%) 2 (1.7%) 0.242 180-209 min - no. (%) 4 (0.8%) 2 (1.7%) 0.320 ≥210 min - no. (%) 3 (0.6%) 0 (0.0%) 1.000 D2B, Door-to-Balloon; IQR, interquartile range.
Transcript of REVASCULARIZING ELDERLY PATIENTS WITH ACUTE ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION UNDER 90...
i2 SUMMIT
E1806
JACC April 5, 2011
Volume 57, Issue 14
REVASCULARIZING ELDERLY PATIENTS WITH ACUTE ST-SEGMENT ELEVATION MYOCARDIAL
INFARCTION UNDER 90 MINUTES: IS IT ACHIEVABLE? RESULTS FROM THE AURORA ST. LUKE’S 24X7
STEMI PROGRAM
i2 Poster ContributionsErnest N. Morial Convention Center, Hall F
Sunday, April 03, 2011, 3:30 p.m.-4:45 p.m.
Session Title: PCI - Acute MIAbstract Category: 6. PCI - Acute MI
Session-Poster Board Number: 2506-564
Authors: M. Fuad Jan, Naoyo Mori, Anjan Gupta, Suhail Allaqaband, Tanvir Bajwa, Aurora Cardiovasc Svcs, Aurora Sinai/St. Luke’s Med Ctrs, Univ Wisconsin Sch Med & Public Health, Milwaukee, WI, Center for Urban Population Health, University of Wisconsin-Milwaukee, Milwaukee, WI
Background: Limited data exists on door-to-balloon times (D2B) in elderly patients with acute ST-segment elevation myocardial infarction (STEMI)
treated by primary percutaneous coronary intervention (PPCI). We compared D2B between elderly (age ≥75) and younger patients using a novel
STEMI protocol.
Methods: From April 2004 to June 2009, 611 patients with acute STEMI presented directly to our emergency department and underwent PPCI
under the Aurora St. Luke’s 24x7 STEMI Program: a team of an interventional cardiologist, registered nurse and two cardiovascular technologists
in-hospital 24 hours a day, 7 days a week. We recorded patients as elderly (≥75 years) or younger (<75 years).
Results: Of 611 consecutive STEMI patients, 116 (19.0%) were elderly, (median age 81; median age of younger group: 58). Compared with younger
patients, the elderly were more often female (54.3% vs. 24.7%, p<0.001) and hypertensive (72.4% vs. 53.3%, p<0.001). Heart failure (7.8% vs.
1.6%, p<0.001), peripheral artery disease (12.1% vs. 4.0%, p<0.001) and cardiogenic shock (13.6% vs. 7.0%, p=0.030) were also more common in
elderly. Elderly had longer D2B (61 vs. 53 min, p=0.009), but D2B < 90 min was still achieved in 86.2% (100 of 116) versus 89.8% (445 of 495) in
younger group (p=NS) (Table).
Conclusion: Aurora St. Luke’s 24x7 STEMI Program - an important demonstration project in systems improvement - shows it is possible to achieve
revascularization within 90 minutes not only in the general STEMI population but also in the elderly.
Door-to-Balloon Times by Age
Characteristic Younger than 75 75 and olderp-Value
No. patients (%) 495 (81.0%) 116 (19.0%)
Door-to-Balloon Time
Median D2B time - min (IQR) 53 (42-71) 61 (48-74) 0.009
<30 min - no. (%) 36 (7.3%) 5 (4.3%) 0.307
30-59 min - no. (%) 267 (53.9%) 51 (44.0%) 0.067
60-89 min - no. (%) 142 (28.7%) 44 (37.9%) 0.067
90-119 min - no. (%) 29 (5.9%) 10 (8.6%) 0.377
120-149 min - no. (%) 11 (2.2%) 2 (1.7%) 1.000
150-179 min - no. (%) 3 (0.6%) 2 (1.7%) 0.242
180-209 min - no. (%) 4 (0.8%) 2 (1.7%) 0.320
≥210 min - no. (%) 3 (0.6%) 0 (0.0%) 1.000
D2B, Door-to-Balloon; IQR, interquartile range.
