Factors associated with the use of percutaneous coronary intervention in elderly Chinese patients with a first ST elevated acute myocardial infarction

Abstract

Shan Zhou,1 Jie Chen,2 Ru-Yi Xu,1 Hai-Yun Wu2 1Chinese Navy General Hospital, Fucheng, Beijing, People's Republic of China; 2Institute of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, People's Republic of China Introduction: Rapid reperfusion therapies (RT), particularly percutaneous coronary intervention (PCI), improve short- and long-term outcomes in patients with ST segment elevation myocardial infarction (STEMI). However, a substantial proportion of patients with STEMI, especially older patients, refuse or do not undergo PCI. Our study aims to identify factors associated with the use of PCI in elderly Chinese patients with their first STEMI. Method: Elderly (aged 65 years of age or over) patients with STEMI were enrolled between March 2010 and August 2013 at two hospitals in Beijing. Patients with previous myocardial infarction and those with contraindications to reperfusion were excluded. A standardized questionnaire including onset time and severity of symptoms, history of angina pectoris, comorbid illnesses, functional status, family income, health insurance, education, patients' trust in treating physicians, and whether patient was acquainted with a cardiologist was used to collect data from patients or their family. Results: Five hundred and sixty-eight patients were enrolled. PCI was accepted by 432 (76%) and refused by 136 (24%). Multivariate analysis showed that older age (>75 years; odds ratio [OR], 0.57; 95% confidence interval [CI], 0.23–0.78), self-rated mild symptoms (OR, 0.12; 95% CI, 0.06–0.21), lower degree of trust in treating physician (<6 in a 10 point scale; [OR, 0.14; 95% CI, 0.09–0.28]), and not being acquainted with a cardiologist (OR, 0.28; 95% CI, 0.07–0.42) were associated with refusal of PCI. Conclusion: PCI was refused by almost one quarter of eligible elderly Chinese patients with a first STEMI. Age, symptom severity, and trust in physician were independent factors associated with the use of PCI in these patients. Keywords: elderly, acute myocardial infarction, percutaneous coronary intervention