Admission Therapies After MI and Life Expectancy in Elderly

May 19, 2016
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Authors:
Bucholz EM, Butala NM, Normand SL, Wang Y, Krumholz HM.
Citation:
Association of Guideline-Based Admission Treatments and Life Expectancy After Myocardial Infarction in Elderly Medicare Beneficiaries. J Am Coll Cardiol 2016;67:2378-2391.
Summary By:
Prashant Vaishnava, MD, FACC

Study Questions:

What is the association of five acute myocardial infarction (AMI) therapies (aspirin, beta-blockers, acute reperfusion therapy, door-to-balloon time (D2B) ≤90 minutes, and time to fibrinolysis ≤30 minutes) with life expectancy and years of life saved?

Methods:

This was a retrospective analysis of data from the Cooperative Cardiovascular Project, a study of Medicare beneficiaries hospitalized for AMI, with 17 years of follow-up. The authors evaluated the association between life expectancy after AMI and three guideline-based admission therapies (aspirin within 48 hours of admission, beta-blockers within 48 hours of admission, and acute reperfusion therapy within 12 hours of admission) and two reperfusion guidelines (D2B within 90 minutes and door-to-needle [D2N] within 30 minutes of hospital arrival).

Results:

In adjusted analyses, aspirin on admission was associated with 0.65 (standard error [SE] 0.05) years of life saved on average, beta-blockers with 0.45 (SE 0.06) years of life saved, and acute reperfusion therapy with 0.90 (SE 0.11) years of life saved among eligible patients. In adjusted analyses, D2B times ≤90 minutes were associated with 0.98 (SE 0.47) years of life saved and D2N times ≤30 minutes were associated with 0.52 (SE 0.17) years of life saved.

Conclusions:

Select AMI-based therapies (aspirin, beta-blockade, acute reperfusion, D2B ≤90 minutes, and D2N ≤30 minutes) were associated with increased life expectancy among older patients.

Perspective:

This is a valuable contribution that establishes the long-term benefits and increased longevity (over 17 years of follow-up) associated with the use of guideline-based AMI therapies. This is particularly important and novel, given the focus on an older population. Future efforts should focus on mechanisms through which to improve adherence to guideline-based care for acute coronary syndromes.

Keywords: Acute Coronary Syndrome, Adrenergic beta-Antagonists, Aged, Aspirin, Fibrinolysis, Geriatrics, Guidelines as Topic, Life Expectancy, Medicare, Myocardial Infarction, Percutaneous Coronary Intervention, Reperfusion


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