In‐Hospital mortality of elderly patients with acute myocardial infarction: Data from the mitra (maximal individual therapy in acute myocardial infarction) registry

• Published in: Clinical cardiology (Mahwah, N.J.) N.J.), 2000-11, Vol.23 (11), p.831-836
• Main Authors: Haase, K. K., Schiele, R., Wagner, S., Fischer, F., Burczyk, U., Zahn, R., Schuster, S., Senges, J.
• Format: Article
• Language: English
• Subjects: acute myocardial infarction; age; Age Factors; Aged; Aged, 80 and over; Angioplasty, Balloon, Coronary; Biological and medical sciences; Cardiology. Vascular system; Clinical Investigation; Coronary heart disease; early therapy; Female; Germany; Heart; Hospital Mortality; Humans; Male; Medical sciences; Myocardial Infarction - mortality; Myocardial Infarction - therapy; Registries; Stroke - etiology; Thrombolytic Therapy; Time Factors
• ISSN: 0160-9289; 1932-8737
• DOI: 10.1002/clc.4960231109

Background: Advanced age remains one of the principal determinants of mortality in patients with acute myocardial infarction (AMI). Hypothesis: The aim of this study was to determine the in‐hospital outcome of elderly (>75 years) patients with AMI who were admitted to hospitals participating in the national MITRA (Maximal Individual Therapy in Acute Myocardial Infarction) registry. Methods: MITRA is a prospective, observational German multicenter registry investigating current treatment modalities for patients presenting with AMI. All patients with AMI admitted within 96 h of onset of symptoms were included in the MITRA registry. MITRA was started in June 1994 and ended in January 1997. This registry comprises 6,067 consecutive patients with a mean age of 65 ± 12 years, of whom 1,430 (17%) were aged > 75 years. Patients were compared with respect to patient characteristics, prehospital delays, early treatment strategies, and clinical outcome. Results: In the elderly patient population, the prehospital delay was 210 min, which was significantly longer than that for younger patients (155 min, p = 0.001). Although the incidence of potential contraindications for the initiation of thrombolysis was almost equally distributed between the two age groups (8.7 vs. 8.2%, p = NS), elderly patients (> 75 years) received reperfusion therapy less frequently (35.9 vs. 64.6%) than younger patients. Mortality increased with advanced age and was 26.4% for all patients aged > 75 years. If reperfusion therapy was initiated, in‐hospital mortality was 21.8 versus 28.9% in patients aged > 75 years (p = 0.001) and 29.4 versus 38.5% in patients aged > 85 years (p = 0.001). Conclusion: In this registry, elderly patients with AMI had a much higher in‐hospital mortality than that expected from randomized trials. In MITRA, the mortality reduction with reperfusion therapy was found to be highest in the very elderly patient population.