To analyze secular trends in management and short and long-term prognosis of elderly presenting with ST-elevation myocardial infarction (STEMI). All patients ≥75 years with first STEMI admitted to our Coronary Care Unit between 1988 and 2008 were included. Baseline characteristics, clinical management, in-hospital and post-discharge outcomes in 4 time periods (1988–1993, 1994–1998, 1999–2003, 2004–2008) were compared. The final cohort consisted of 1393 patients. During the study period, there was a significant increase in the use of aspirin, β-blockers and ACE inhibitors. A significant reduction in the development of cardiogenic shock and mechanical complications was noticed. The use of reperfusion therapy increased significantly, due to a wider use of primary percutaneous coronary intervention (PPCI) while 30-days, 1-year and 5-year mortality decreased throughout the 20-year study period (p<0.001). In the multivariable logistic regression model, patients treated with PPCI showed a significantly lower 30-day (OR 0.47, 95% CI, 0.31–0.71), 1-year (OR 0.62, 95% CI 0.43–0.88) and 5-year mortality (OR 0.57, 95% CI 0.41–0.79) while patients receiving fibrinolysis showed a non-significant improvement in 30-day (OR 0.86, 95% CI 0.62–1.49), 1-year (OR 0.86, 95% CI 0.58–1.30) and 5-year mortality (OR 0.82, 95% CI 0.56–1.19). The use of reperfusion therapy, and particularly of PPCI, for elderly patients suffering from STEMI increased significantly during the study period. This change in therapy was associated with a marked improvement in short and long-term prognosis.

There are limited data regarding the need for intensive care or the appropriate length of hospital stay for patients with ST elevation acute myocardial infarction (STEMI). In order to optimize resources, we tried to determine the need of coronary care unit (CCU) admission for patients with STEMI who remained in Killip class I after a successful primary percutaneous coronary intervention (PPCI). From August of 2006 till June of 2008, we analyzed data from all patients admitted in our CCU who met these criteria, a total of 278. We prospectively recorded all in-hospital adverse events and event-free survival at 30 and 90 days (all cause death, stroke, new acute coronary syndrome or re-hospitalization due to heart failure). Medical treatment was optimized according to the current guidelines. A coronary stent was implanted in 96% of the patients. None of the patients had any adverse event that could not be resolved in a step-down unit. Survival at 30 and at 90 days was 99.6% and 98.3% respectively. Event-free survival was 97.3% at 30 days and 94.3% at 90 days. The median length of stay was three days in the CCU and five days in the hospital. Patients with STEMI treated with PPCI who remained in Killip class I after the procedure and receive optimal pharmacological treatment have an excellent prognosis. All of them can probably be admitted safely to a step-down unit. Wide application of this management strategy may result in substantial cost savings.

Cardiogenic shock (CS), as the most severe form of heart failure, is associated with very high mortality rates despite therapeutic advances in the last decades. Gender differences in outcomes have been widely reported regarding several cardiovascular diseases. The aim of our study was to evaluate potential gender disparities in clinical presentation, management, and in-hospital outcomes of all (n = 138) patients admitted to the Acute Cardiac Care Unit of a tertiary hospital from 2013 to 2019. Information on demographic characteristics, past medical history, haemodynamic and clinical status at admission, therapeutic management, and in-hospital outcomes was retrospectively collected. Women represented 31.88% of the cohort, were significantly older than the men and had a lower proportion of smokers, chronic obstructive pulmonary disease, and previous acute myocardial infarction (AMI). Most CSs in both groups were AMI-related. Left ventricular ejection fraction at admission was higher in women, who were less likely to receive vasopressors. No differences were observed regarding mechanical circulatory support use and in-patient outcomes, with age being the only factor associated with in-hospital mortality on multivariate analysis.