Differing Clinical Characteristics Between Young and Older Patients Presenting with Myocardial Infarction.

BACKGROUND: To date, there has been no detailed study of the risk factors and clinical characteristics of patients presenting with myocardial infarction (MI) at a young age in our region. The purpose of this study was to assess the rate and clinical profile of those presenting with young MI in New Zealand. METHODS: We identified a cohort of 1199 patients presenting with acute MI between January 2012 and November 2015 from the Wellington Acute Coronary Syndrome Registry. We compared those presenting with young MI, defined as presentation with MI aged 50 years or younger, to those aged over 50 years. RESULTS: Myocardial infarction at a young age occurred in 154 (12.8%) patients. Compared to those in the older MI group, the young MI group were more likely to be male (80% vs. 71%, p=0.026), of Maori or Pacific Island ethnicity (21% vs. 10%, p<0.0001), have a higher BMI (31kg/m2 vs. 29kg/m2, p<0.0001), have a family history of premature coronary artery disease (49% vs. 34%, p<0.0001) and to be current smokers (47% vs. 20%, p<0.001). Young MI patients were less likely to have hypertension, dyslipidaemia and diabetes than the older MI patient population. Within the young MI group 36% had none or only one traditional risk factor for MI, and would have been classified as low risk prior to their index event. CONCLUSION: Those with young MI accounted for 12.8% of our cohort and had a different risk factor profile to the older MI group with smoking and obesity being particularly prevalent.

Same-day discharge is feasible and safe in the majority of elderly patients undergoing elective percutaneous coronary intervention.

BACKGROUND: Same-day discharge after elective percutaneous coronary intervention (PCI) is safe in the majority of patients. However, the elderly have more comorbidities and less favorable coronary and peripheral arterial anatomy, which may preclude safe same-day discharge after PCI. We assessed the feasibility and safety of same-day discharge in an elderly cohort of patients. METHODS: A total of 1,580 consecutive patients undergoing elective PCI in a single center between January 2001 and January 2009 were included in the study. We compared the outcomes of elderly patients aged 75 or older to control patients under the age of 75 years. Patients were examined 6 hours post procedure and discharged if there were no complications. RESULTS: Of the 1,580 study patients 212 (13.4%) were elderly and 1,365 (86.6%) were younger controls. The elderly were more likely to be female, hypertensive and to have had previous coronary artery bypass graft (CABG) surgery and less likely to be smokers or to have hyperlipidemia (all p < 0.05). The number of lesions treated and their complexity were similar in both groups. Procedural success, in-hospital major adverse cardiac events (MACE) and the rates of same-day discharge were also similar in both groups. Same-day discharge was achieved in the majority (84%) of the elderly. There were no deaths within 24 hours of discharge. Readmission within 24 hours of discharge was rare (< 0.7%) in both groups. The 30-day MACE rate was low in both the elderly (3.3%) and control groups (3.6%; p = 1.0). CONCLUSIONS: Same-day discharge is safe and feasible in the majority of elderly patients following elective PCI.

Paramedic-administered prehospital thrombolysis is safe and reduces time to treatment.

INTRODUCTION: The Kapiti Coast region is remote from Wellington Hospital with an ambulance transport time of 1 hour. To reduce delays in the treatment of myocardial infarction (MI), a prehospital thrombolysis (PHT) programme was initiated in 2003. METHODS: This study evaluated outcomes of the Kapiti PHT programme between 2003 and 2007. Paramedics attending patients with suspected MI-transmitted electrocardiograms to our Coronary Care Unit where a physician made the decision whether or not to thrombolyse. Thrombolysis was then administered by a paramedic. Patients from the Kapiti region treated with in-hospital thrombolysis (IHT) between 1999 and 2003 formed the control group. RESULTS: A total of 50 Kapiti patients received PHT. The group receiving IHT were older than those receiving PHT but other baseline characteristics were similar. No patients without MI or with a contraindication received PHT. In the PHT group there was one minor bleed but no major bleeding, stroke or death occurred during transport to hospital. The median scene to thrombolytic time for PHT was 89 minutes faster (44 minutes versus 133, P<0.0001) than in patients transferred for IHT. The median scene to thrombolytic time for PHT was similar to the door to thrombolytic time for IHT (P=0.13). In-hospital mortality in the PHT group (8.0%) was similar to the IHT group (6.0%, P=1.0) but heart failure was reduced (10% vs. 26%, P=0.04) CONCLUSIONS: Prehospital thrombolysis administered by paramedics is safe and reduces the time to treatment and was associated with a reduction in heart failure.