The following is the summary of “Impact of Age at the Time of the First ST-Elevation Myocardial Infarction on 10-Year Outcomes (from the EXAMINATION-EXTEND Trial)” published in the December 2022 issue of Cardiovascular Disease by Arévalos, et al.
The purpose of this EXAMINATION-EXTEND substudy was to examine long-term outcomes for patients 10 years after their first ST-elevation myocardial infarction (STEMI) by age group. Patients having a history of coronary ischemic event or ischemic stroke were not included in this analysis of the 1,498 patients with STEMI who participated in the EXAMINATION-EXTEND investigation. Patients with ages (<55, 55–65, 65–75, and >75) made up the remaining 1,375. About 10 patient-oriented composite end point (POCE) of all-cause death, any MI, or any revascularization was the primary end point.
Patients younger than 55 years old had a lower risk of POCE than those older than 75 years old at 10 years of follow-up (adjusted hazard ratio [HR] 0.24, 95% CI 0.18 to 0.31, P=0.001), as did those between the ages of 55 and 65 (adjusted HR 0.26, 95% CI 0.20 to 0.34, P=0.001) and 65 and 75 (adjusted HR 0. Death from cardiac causes increased with age (<55: 3.7%, 55-65: 5.8%, 65-75: 10.9%, >75: 35.5%, P=0.001).
Between 5 and 10 years of follow-up, younger patients had a higher incidence of any revascularization in the landmark analyses (55: 7.4% vs. 55–65: 4.9% vs. 65–75: 1.8% vs. >65: 1.6%, P=0.001). In conclusion, at a 10-year follow-up, individuals older than 65 were more likely to have suffered a POCE due to all-cause or cardiac mortality following their initial STEMI. On the flip side, revascularization was more likely to occur in younger patients throughout the long-term follow-up.