Background: There is little research in the efficacy and safety of a pharmaco-invasive strategy (PIS) in patients ≥75 years versus <75 years of age. We aimed to evaluate and compare the influence of advanced age on the risk of death and major adverse cardiac events (MACE) in patients undergoing PIS. Methods: Between January 2010 and November 2016, 14 municipal emergency rooms in São Paulo, Brazil, used full-dose tenecteplase to treat patients with STEMI as part of a pharmaco-invasive strategy for a local network implementation. Results: A total of 1852 patients undergoing PIS were evaluated, of which 160 (9%) were ≥75 years of age. Compared to patients <75 years, those ≥75 years were more often female, had lower body mass index, higher rates of hypertension; higher incidence of hypothyroidism, chronic renal failure, prior stroke, and diabetes. Compared to patients <75 years of age, in-hospital MACE and mortality were higher in patients with ≥75 years (6.5% versus 19.4%; p<0.001; and 4.0% versus 18.2%; p<0.001, respectively). Patients ≥75 years had higher rates of in-hospital major bleeding (2.7% versus 5.6%; p=0.04) and higher incidence of cardiogenic shock (7.0% versus 19.6%; p<0.001). By multivariable analysis, age ≥75 years was independent predictor of MACE (OR 3.57, 95% CI 1.72 to 7.42, p=0.001) and death (OR 2.07, 95% CI 1.12-3.82, p=0.020). Conclusion: In patients with ST-segment elevation myocardial infarction undergoing PIS, age ≥75 years was an independent factor that entailed a 3.5-fold higher MACE and 2-fold higher mortality rate compared to patients <75 years of age.

No abstract

ObjectiveTo validate the Intra-aortic Balloon Pump in Cardiogenic Shock II (IABP-SHOCK II) score in patients with cardiogenic shock after ST elevation myocardial infarction (STEMI) treated with pharmacoinvasive strategy (PhIS) and to analyse the influence of ischaemia time on different risk strata.MethodsWe analysed 2143 patients with STEMI who underwent reperfusion with tenecteplase in primary health services between May 2010 and April 2017 and were transferred to a tertiary hospital for cardiac catheterisation and continuity of care. Those who evolved to cardiogenic shock were scored as low (0–2), moderate (3–4) or high (5–9) risk of death in 30 days and pairwise-log-rank test was used to compare strata. Time intervals between symptoms onset and lytic (pain-to-needle) and fibrinolytic-catheterisation were also compared.ResultsCardiogenic shock occurred in 212 (9.9%) individuals. The 30-day mortality using the IABP-SHOCK II score was 26.6% for low-risk (n=94), 53.2% for moderate-risk (n=62) and 76% for high-risk (n=25) analysed patients (p<0.001). Validation of the score showed good discrimination for death, area under the curve of 0.73 (CI: 0.66 to 0.81; p<0.001). The median intervals of pain-to-needle and fibrinolytic-catheterisation showed no association with the group stratification (220 vs 251 vs 200 min; p=0.22 and 390 vs 435 vs 315 min; p=0.18, respectively).ConclusionsIn patients with cardiogenic shock after STEMI treated with PhIS, risk stratification using IABP-SHOCK II score was adequate. There was no influence of pain-to-needle and fibrinolytic-catheterisation times on the ability to the score model stratification.

No abstract

No abstract

No abstract

No abstract

Introduction Despite worse cardiovascular outcomes, including higher mortality, reported in women with acute myocardial infarction, it is uncertain whether these differences can be explained by a discordant risk profile between genders. Objective To compare clinical data and metrics of care between women and men diagnosed with ST elevation myocardial infarction (STEMI). Methods We analyzed 2723 consecutive STEMI patients, of whom 29.8% (811) were women, treated in a regional network from March-2010 to December-2019, first seen in primary hospitals, where they received fibrinolysis (96% tenecteplase), and then systematically transferred to a tertiary center for cardiac catheterization (pharmaco-invasive strategy). Categorical variables were compared using chi-square test and numerical variables expressed as median and interquartile range and compared using Mann-Whitney test. A binary logistic regression model was developed to determine whether female gender was an independent predictor of mortality. Results Compared to men, women were older (60 [53–69] x 56 [49–63] years; p&lt;0.01), had more hypertension (68.9% x 56.5%; p&lt;0.01), diabetes (36.6% x 28.3%; p&lt;0.01), hypothyroidism (12.0% x 3.3%; p&lt;0.01), kidney failure with an estimated creatinine clearance &lt;60 mL/min (24.7% x 15.4%; p&lt;0.01) and higher baseline LDL-cholesterol (128 [107–160] x 124 [100–154] mg / dL; p=0.03). Smoking (65.2% x 58.2%; p&lt;0.01) and alcoholism (16.1% x 3.1%; p&lt;0.01) were more frequent in men. Regarding the metrics of care, women had longer times from symptoms onset to first medical contact (120 [60–240] x 115 [60–210] minutes; p=0.02) and longer pain-to-needle median times (69 [42–120] x 72 [49–120] minutes; p=0.03). There was no difference between genders regarding percentage of failure reperfusion after lytic, median time from fibrinolysis to cardiac catheterization, maximum troponin values and days of hospitalization. Women had higher unadjusted in-hospital mortality (8.0% x 4.8%; p&lt;0.01). However, after adjusting for confounding variables in the multivariate regression model, the female gender was not an independent predictor of death (odds ratio 1.17 with a 95% confidence interval of 0.69–1.80). Conclusion After adjusting for risk variables, female gender was not related to higher in-hospital mortality in STEMI patients treated with pharmaco-invasive strategy. However, women had a higher cardiovascular risk profile compared to men and worse metrics of care, including greater delay in reperfusion therapy. Funding Acknowledgement Type of funding source: None