Impact of Age at the Time of the First ST-Elevation Myocardial Infarction on 10-Year Outcomes (from the EXAMINATION-EXTEND Trial)

• Published in: The American journal of cardiology Vol. 190; pp. 32 - 40
• Main Authors: Arévalos, Victor, Spione, Francesco, Gabani, Rami, Ortega-Paz, Luis, Gómez-Lara, Josep, Jiménez-Díaz, Víctor, Jiménez, Marcelo, Jiménez-Quevedo, Pilar, Diletti, Roberto, Pineda, Javier, Campo, Gianluca, Silvestro, Antonio, Maristany, Jaume, Flores, Xacobe, Oyarzabal, Loreto, Bastos-Fernandez, Guillermo, Iñiguez, Andrés, Serra, Antonio, Escaned, Javier, Ielasi, Alfonso, Tespili, Maurizio, Lenzen, Mattie, Fernández-Ortiz, Antonio, Bordes, Pascual, Tebaldi, Matteo, Biscaglia, Simone, Al-Shaibani, Soheil, Romaguera, Rafael, Gómez-Hospital, Joan Antoni, Rodes-Cabau, Josep, Serruys, Patrick W., Sabaté, Manel, Brugaletta, Salvatore
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2023; Elsevier Limited
• Subjects: Age; Age groups; Aged; Body mass index; Cardiovascular disease; Cerebral infarction; Death; Diabetes; Drug-Eluting Stents; Family medical history; Gender; Heart; Heart attacks; Humans; Hypertension; Ischemia; Medical prognosis; Mortality; Myocardial infarction; Percutaneous Coronary Intervention - adverse effects; Risk assessment; Risk Factors; ST Elevation Myocardial Infarction - epidemiology; ST Elevation Myocardial Infarction - etiology; ST Elevation Myocardial Infarction - surgery; Stents; Time Factors; Treatment Outcome; Spain
• ISSN: 0002-9149; 1879-1913; 1879-1913
• DOI: 10.1016/j.amjcard.2022.11.035

The aim of this substudy of the EXAMINATION-EXTEND was to analyze 10-year outcomes according to the patient's age at the time of the first ST-elevation myocardial infarction (STEMI). Of 1,498 patients with STEMI included in the EXAMINATION-EXTEND study, those with a previous history of coronary ischemic even or ischemic stroke were excluded from this analysis. The remaining 1,375 patients were divided into 4 age groups: <55, 55 to 65, 65 to 75, and >75 years. The primary end point was 10-year patient-oriented composite end point (POCE) of all-cause death, any MI, or any revascularization. At 10-year follow-up, patients aged <55 years (adjusted hazard ratio [HR] 0.24, 95% confidence interval [CI] 0.18 to 0.31, p = 0.001), 55 to 65 years (adjusted HR 0.26, 95% CI 0.20 to 0.34, p = 0.001), and 65 to 75 years (adjusted HR 0.38, 95% CI 0.30 to 0.50, p = 0.001) showed lower risk of POCE than those aged >75 years, led by a lower incidence of all-cause death (<55 : 6% vs 55 to 65: 11.9% vs 65 to 75: 25.7% vs >75 years: 61.6%, p = 0.001). Cardiac death was more prevalent in the older group (<55: 3.7% vs 55 to 65: 5.8% vs 65 to 75: 10.9% vs >75 years: 35.5%, p = 0.001). In the landmark analyses, between 5- and 10-year follow-up, young patients exhibited a higher incidence of any revascularization (<55: 7.4% vs 55 to 65: 4.9% vs 65 to 75: 1.8% vs >65 years: 1.6%, p = 0.001). In conclusion, in patients with a first STEMI, advanced age was associated with high rates of POCE at 10-year follow-up due to all-cause and cardiac death. Conversely, younger patients exhibited a high risk of revascularization at long-term follow-up.