Related Experiment Video
Updated: Jul 14, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Revascularization algorithm in acute STEMI should take into account age
Axel de Labriolle1, Bruno Giraudeau, Gérard Pacouret
1Département de Cardiologie, Centre Hospitalier Universitaire Tours, Tours, France. a.delabriolle@chu-tours.fr
Insights
For elderly STEMI patients, time to treatment impacts outcomes differently based on reperfusion strategy. Primary PCI showed a correlation between longer treatment times and mortality, unlike thrombolysis.
Area of Science:
- Cardiology
- Geriatric Medicine
- Interventional Cardiology
Background:
- Optimal reperfusion strategy for elderly ST-segment elevation myocardial infarction (STEMI) patients remains debated.
- Limited data exists on the impact of time to treatment (TT) on STEMI prognosis in this demographic.
Purpose of the Study:
- To analyze the real-world association between time to treatment (TT) and 1-year mortality in elderly STEMI patients (> or =75 years).
- To compare outcomes for patients treated with thrombolysis (THL) versus primary percutaneous coronary intervention (PCI).
Main Methods:
- Prospective registry data from 1995-2005 was analyzed for 159 elderly STEMI patients (<12h symptom onset).
- Patients underwent either THL (n=35) or primary PCI (n=124).
- Logistic regression assessed the relationship between TT and 1-year mortality for each reperfusion strategy.
Main Results:
- Time to treatment was not significantly associated with mortality after thrombolysis (P=.81).
- Time to treatment was positively correlated with mortality after primary PCI (P=.03).
- One-year all-cause mortality was significantly higher in the THL group (51.4%) compared to the PCI group (15.3%; P<.001).
Conclusions:
- Reperfusion strategies used for younger STEMI patients may not be suitable for the elderly.
- Specific treatment algorithms and recommendations are necessary for optimizing STEMI care in elderly populations.
Background:
In the elderly patients, the optimal reperfusion strategy of acute ST-segment elevation myocardial infarction (STEMI) remains a topic of debate. Moreover, there is a lack of data regarding the effect of time to treatment (TT) on prognosis of STEMI in elderly patients.
Purpose:
The goal of our work was to analyze, in real life, the link between TT and 1-year mortality in patients with STEMI (> or =75 years) who were treated with thrombolysis (THL) or primary percutaneous coronary intervention (PCI).
Methods And Materials:
Data were extracted from our university hospital prospective registry. Between 1995 and 2005, all patients who met the criteria (> or =75 years old, has had an acute STEMI <12 h, has been admitted directly into our cardiologic care unit, and has had a revascularization procedure) were included in the analysis. Using logistic regression, we studied the relation between TT and 1-year mortality for each strategy of reperfusion in patients with STEMI who were > or =75 years old.
Results:
One hundred fifty-nine consecutive patients with STEMI <12 h were analyzed; 35 were treated with THL and 124 were treated with primary PCI. Mean age (+/-S.D.) was 80+/-4 years, and 56% of patients were men. In logistic regression analysis, TT was not associated to death after THL (P=.81), while it was positively correlated after PCI (P=.03). All-cause 1-year mortality was markedly higher in the THL group than in the PCI group (51.4% vs. 15.3%; P<.001).
Conclusion:
Our work suggests that the extrapolation of algorithm of revascularization used in younger patients is not appropriate for elderly patients. Specific algorithm of revascularization and recommendations are needed in elderly patients.
Related Concept Videos
01:30Acute Coronary Syndrome I: Introduction
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:26Acute Coronary Syndrome V: Nursing Management
01:17Ischemic Heart Disease: Overview
Atherosclerosis, the primary malefactor, orchestrates this dangerous condition. It manifests as the accumulation of fatty deposits, akin to insidious plaques, within arterial walls. As time elapses, these plaques metamorphose, hardening and narrowing...
01:25Cardiopulmonary Resuscitation IV: Pharmacological Management