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Outcomes after STEMI in old multimorbid patients with complex health needs and the effect of invasive management
Sahlgrens Univ Hosp, Dept Geriatr, Gothenburg, Sweden;Landspitali Univ Hosp, Dept Cardiol, Reykjavik, Iceland;Landspitali Univ Hosp, Cardiovas Res Ctr, Reykjavik, Iceland;Univ Iceland, Sch Hlth Sci, Reykjavik, Iceland.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.ORCID iD: 0000-0003-4413-9736
Landspitali Univ Hosp, Dept Cardiol, Reykjavik, Iceland;Landspitali Univ Hosp, Cardiovas Res Ctr, Reykjavik, Iceland;Univ Iceland, Sch Hlth Sci, Reykjavik, Iceland.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
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2019 (English)In: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 211, p. 11-21Article in journal (Refereed) Published
Abstract [en]

Background: The aim of this study was to assess one-year outcomes of invasive and non-invasive strategies in ST-elevation myocardial infarction (STEMI) among multimorbid older people with complex health needs.

Methods: We included patients, registered between 2006 and 2013 in the SWEDEHEART registry, who were 70 years old or older with STEMI, had multimorbidily and complex health needs and were discharged alive. The one-year outcomes of patients who underwent invasive strategy (examined with coronary angiography <= 14 days) were compared to those who did not. The primary event was a composite of all-cause death, admission due to new acute coronary syndrome, stroke or transient ischemic attack.

Results: We identified patients, and 1089 were managed invasively and 570 non-invasively. The mean age was 79 years and 83 years in the 2 groups, respectively. After multivariable adjustment for baseline differences between the groups, including propensity scores, the primary event occurred in 31% of patients in the invasive group and 55% in the non-invasive group, adjusted hazard ratio (95% confidence intervals): 0.67 (0.54-0.83). One-year mortality was 18% in the invasive group and 45% in the non-invasive group, adjusted hazard ratio 0.51 (0.39-0.65).

Conclusions: Multimorbid older people with complex health needs and STEMI had high rates of new ischemic events and death. In this cohort of older, high risk STEMI patients, an invasive strategy was associated with lower event rates. Randomized studies are needed to clarify whether these high risk patients who might benefit from invasive care are being managed too conservatively.

Place, publisher, year, edition, pages
MOSBY-ELSEVIER , 2019. Vol. 211, p. 11-21
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Cardiac and Cardiovascular Systems
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URN: urn:nbn:se:uu:diva-382820DOI: 10.1016/j.ahj.2019.01.008ISI: 000464522600002PubMedID: 30831330OAI: oai:DiVA.org:uu-382820DiVA, id: diva2:1313711
Available from: 2019-05-06 Created: 2019-05-06 Last updated: 2019-05-06Bibliographically approved

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James, StefanLagerqvist, BoVarenhorst, Christoph

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