Age differences in the adherence to treatment guidelines and outcome in patients with ST-elevation myocardial infarction

Shmuel Gottlieb, Solomon Behar, Roseline Schwartz, David Harpaz, Avraham Shotan, Doron Zahger, Hanoch Hod, Dan Tzivoni, Mady Moriel

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


The aim of this study was to assess age differences in the utilization of class-I treatment guidelines and its effect on mortality in patients with ST-elevation myocardial infarction (STEMI). The study included 1026 consecutive patients from the prospective nationwide Acute Coronary Syndrome Israeli Survey (ACSIS). Primary reperfusion was used less often among elderly (age > 75 years) patients than among those aged 65-74 and <65 years (46%, 63%, 64%, respectively, p (for trend). = 0.004). Class-I evidence-based medications (EBM) at discharge (aspirin, β-blockers, angiotensin converting-enzyme inhibitors. = ACEI, angiotensin receptor-blockers. = ARBs and statins) were less frequently prescribed to elderly compared to younger age-subgroup (44%, 61%, 57%, respectively; adjusted odds ratio (OR). = 0.62; 0.40-0.97 for age ≥ 75 vs. age < 65 years). Early and 1-year mortality rates were 3-5-fold higher among the elderly compared to patients <65 years. In the entire cohort use of primary reperfusion was associated with lower 1-year mortality (OR. = 0.69; 0.47-1.01), as was the use of EBM (OR. = 0.26; 0.17-0.41). These effects were similar across all age-subgroups but with a greater impact among the elderly, as the number of patients needed to treat (NNT) was significantly lower with advancing age. Better adherence to treatment guidelines may improve the prognosis of elderly patients with STEMI.

Original languageEnglish
Pages (from-to)118-124
Number of pages7
JournalArchives of Gerontology and Geriatrics
Issue number1
StatePublished - 1 Jan 2011
Externally publishedYes


  • Aging
  • Angioplasty
  • Drugs
  • Guidelines
  • Myocardial infarction

ASJC Scopus subject areas

  • Health(social science)
  • Aging
  • Gerontology
  • Geriatrics and Gerontology


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