Should primary percutaneous coronary intervention be the routine reperfusion strategy in octogenarians presenting
Refai Showkathali1, Edney Boston-Griffiths, Michael Parker
1aDepartment of Cardiology, The Essex Cardiothoracic Centre, Essex bAnglia Ruskin University, Chelmsford, UK.
Insights
Primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI) in patients 80 years and older shows higher mortality. Further randomized trials are needed to compare STEMI treatment strategies in this elderly population.
Area of Science:
- Cardiology
- Geriatric Medicine
- Interventional Cardiology
Background:
- ST-elevation myocardial infarction (STEMI) management has advanced, but outcomes in very elderly patients (≥80 years) undergoing primary percutaneous coronary intervention (PPCI) require further investigation.
- Randomized trials specifically analyzing PPCI outcomes in octogenarian STEMI patients are scarce.
Purpose of the Study:
- To evaluate the outcomes of PPCI in patients aged 80 years and older admitted with STEMI.
- To compare the results of PPCI in octogenarian patients versus younger patients.
Main Methods:
- An observational study was conducted.
- Data from 1471 patients who underwent PPCI between September 2009 and November 2011 were analyzed.
- Patients were divided into two groups: those aged ≥80 years and those younger than 80 years.
Main Results:
- 16% of PPCI patients (236 out of 1471) were aged 80 years or older (mean age 85 ± 4 years).
- In-hospital mortality (14.4% vs. 2.9%), 30-day mortality (20.3% vs. 4%), and 1-year mortality (28.8% vs. 6.2%) were significantly higher in the ≥80 years group.
- The octogenarian group also showed increased rates of 30-day stent thrombosis (1.7% vs. 0.4%) and major bleeding (5.9% vs. 3%).
Conclusions:
- Mortality in octogenarian STEMI patients treated with PPCI was consistent with previous findings, despite procedural advancements.
- Given the rising number of elderly STEMI patients, randomized trials are essential to determine optimal treatment strategies.
Aim:
Very few randomized trials have analysed the outcome of primary percutaneous coronary intervention (PPCI) for ST elevation myocardial infarction (STEMI) in very elderly patients (≥80 years). An observational study was performed to evaluate the outcome of PPCI in patients of at least 80 years of age who were admitted to our unit.
Methods:
We included all patients undergoing PPCI in our unit from September 2009 to November 2011.
Results:
Of the 1471 patients who underwent PPCI during the study period, 236 (16%) were at least 80 years of age. The mean age was 85 ± 4 years (range 80-99 years, median 85 years). There was a significant difference in in-hospital mortality [14.4 vs. 2.9%, odds ratio (OR) 5.6, 95% confidence interval (CI) 3.4-9.2, P <0.0001], 30-day mortality (20.3 vs. 4%, OR 6.2, 95% CI 4.0-9.5, P <0.0001), 1-year mortality (28.8 vs. 6.2%, OR 6.1, 95% CI 4.2-8.8, P <0.0001), 30-day stent thrombosis (1.7 vs. 0.4%, OR 4.2, 95% CI 1.1-15.9, P = 0.04) and non-coronary artery bypass grafting major bleed (5.9 vs. 3%, OR 2, 95% CI 1.1-3.8, P = 0.03) between patients aged at least 80 years and those less than 80 years.
Conclusion:
The mortality in our patients of at least 80 years was similar to the previously published data, despite the advances in PPCI procedures. Considering the increasing number of octogenarian patients with STEMI at the present time, there is a need for a randomized trial to compare the different treatment strategies for STEMI.
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