Impact of age at the time of the first ST-elevation myocardial infarction on 10-year outcomes. A sub-analysis from the EXAMINATION EXTEND trial

Background

The aim of this post-hoc sub analysis of the EXAMINATION-EXTEND study was to analyze 10-year outcomes according to the age of the patient at the time of the first STEMI.

Methods

Out of 1498 STEMI patients included in the EXAMINATION-EXTEND study, those with a previous history of atherosclerotic cardiovascular disease (coronary ischemic event, ischemic stroke, or previous coronary revascularization) were excluded for this analysis. The remaining 1375 patients were divided into three age groups: <55, 55–65 and >65 years. The primary endpoint was 10-year patient oriented composite endpoint (POCE) of all-cause death, any myocardial infarction (MI), or any revascularization. Secondary endpoints included the individual components of the primary endpoint, cardiac death, target vessel myocardial infarction (TVMI), target lesion revascularization (TLR), and stent thrombosis. The association between age and endpoints was adjusted for baseline confounders.

Results

At 10-year follow-up, patients <55 years (Adjusted hazard ratio [HR]: 0.42, 95% CI: 0.33–0.53, p=0.001), and 55–65 years (Adjusted HR: 0.44, 95% IC: 0.35–0.56, p=0.001) showed lower risk of POCE compared with those >65 years, led by a lower incidence of all-cause death (<55: 5.8% vs. 55–65: 11.3% vs. >65 years: 40.67%, p=0.001). Cardiac death was more prevalent in the older group (<55: 3.5% vs. 55–65: 5.5% vs. >65 years: 21.3%, p=0.001). There were not significant differences in the incidence of TVMI, TLR and stent thrombosis among the different age groups. In the landmark analyses, between 5 and 10-year follow-up, young patients exhibited higher incidence of any revascularization (<55: 7.4% vs. 55–65: 4.9% vs. >65 years: 1.7%, p=0.001) and a trend towards a higher incidence of any MI (<55: 5.2% vs. 55–65: 3.6% vs. >65 years: 1.5%, p=0.064). No differences were found in any other endpoints.

Conclusions

In patients with a first STEMI, advanced age was associated with high rates of POCE at 10-year follow-up, in particular, due to all-cause and cardiac death. Conversely, patients who presented at younger age exhibited a high risk of revascularization at long-term follow-up.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): Abbott Vascular

Gender differences on 10-year outcomes following ST-segment elevation myocardial infarction: a subgroup analysis from the examination extend trial

Background

Short-term outcomes of women following STEMI are worse than men, with specifically a higher mortality rate. However, it is unknown if gender may play a role in long-term outcomes. We aim to assess whether very long-term outcomes following STEMI treatment may be still influenced by gender.

Methods

The EXAMINATION-EXTEND study was an investigator-driven 10-year follow-up of the EXAMINATION trial, which randomly 1:1 assigned 1498 STEMI patients to receive either EES (n=751) or bare metal stent (BMS) (n=747). This is a sub-analysis of this study, according to gender. Primary endpoint was the composite patient-oriented endpoint (POCE, all-cause death, any myocardial infarction, or any revascularization) at 10-year. Secondary endpoints were individual components of the primary endpoint. All the endpoints were adjusted for age.

Results

Out of 1498 STEMI patient, 254 (17%) were women. Overall, women were older, with more arterial hypertension and less smoking history than men. At 10-year, no difference was observed between women and men in terms of POCE (40.6% vs. 34.2%; adjusted hazard ratio (HR) 95% confidence interval [CI]1.14 [0.91–1.42], p=0.259). There was a trend toward a higher all-cause death in women vs. men (27.6%, vs. 19.4%; adjusted HR [95% CI] 1.30 [0.99–1.71], p=0.063), without difference in cardiac death. No differences were present in terms of the other endpoints.

Conclusions

At very long-term follow-up there were no differences in the combined patient-oriented endpoint between women and men, with a trend towards a higher all-cause death in women. These findings may suggest that very long-term healthcare attention following STEMI in women should go beyond reduction of cardiac events.

Funding Acknowledgement

Type of funding sources: Public hospital(s). Main funding source(s): Public hospital