0456: Reperfusion in elderly patients with acute ST-elevation myocardial infarction: results from the RENAU-RESURCOR STEMI network

BackgroundElderly patients with acute ST-elevation myocardial infarction (STEMI) remain undertreated.PurposeTo evaluate the management of elderly STEMI patients treated in a formal regional network of care.MethodsThis prospective analysis, based on data from the ongoing RESURCOR coronary emergency network, involved 6169 patients presenting with an acute STEMI between 2002 and 2011 in the north French Alps.Patients were divided into age groups:<65, 65-74, 75-84 and≥85 years. Reperfusion rates, types, timing and adjunctive medications were compared.The RESURCOR network advocates primary percutaneous coronary intervention (PPCI) over fibrinolysis and bivalirudin over glycoprotein inhibitors (GPI) in the elderly.ResultsLack of reperfusion therapy increased with age (Table).The rate of fibrinolysis was higher than that for PPCI in younger patients whereas the situation was reversed in elderly patients.In patients who had PPCI, use of bivalirudin increased and GPI decreased with age, system delays were similar.ConclusionThese regional French data indicate that elderly STEMI patients receive appropriate management with timely delivered PPCI and bivalirudin; however, a substantial proportion are still undertreated.Abstratct 0456 – Table: Reperfusion rates, types, timing and adjunctive medications among the age groupsAge groups<65 years n=347665-74 years n=123875-84 years n=1147≥85 years n=308P-valueNo reperfusion, n (%)3.85.68.013.6<0.001Fibrinolysis, n (%)1853 (53.3)593 (47.9)449 (39.2)87 (28.3)<0.001Primary PCI, n (%)1492 (42.9)576 (46.5)606 (52.8)179 (58.1)<0.001Delay (first medical contact to PPCI), median (IQR), min80 (58-123)85 (60-125)85 (64-130)84 (60-124)0.1Bivalirudin*, n/N (%)81/1197 (6.8)30/429 (7.0)48/373 (12.9)28/121(23.1)