Prognosis of primary percutaneous coronary intervention in elderly patients with ST-elevation myocardial infarction
Abdullah Alkhushail1, Sanjay Kohli2, Andrew Mitchel2
1Department of Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia ; Department of Cardiology, Harefield Hospital, London, United Kingdom.
Insights
Primary percutaneous coronary intervention (PPCI) significantly improves survival rates in elderly patients with ST-elevation myocardial infarction (STEMI) compared to medical therapy (MT). PPCI also demonstrated fewer comorbidities, offering a better prognosis for this vulnerable population.
Area of Science:
- Cardiology
- Geriatric Medicine
- Interventional Cardiology
Background:
- ST-elevation myocardial infarction (STEMI) poses a significant threat to elderly individuals.
- Treatment options for STEMI in patients over 80 include primary percutaneous coronary intervention (PPCI) and medical therapy (MT).
- Prognostic differences between PPCI and MT in this specific demographic require thorough evaluation.
Purpose of the Study:
- To compare the long-term prognosis of elderly patients (above 80 years) with STEMI treated with PPCI versus MT.
- To assess survival rates and comorbidity profiles associated with each treatment strategy.
Main Methods:
- A retrospective study included 238 STEMI patients over 80 years old.
- Patients were divided into two groups: PPCI (n=186) and MT (n=52).
- Exclusion criteria included non-STEMI ECG findings, negative troponin, left bundle branch block, and normal coronaries.
Main Results:
- PPCI group survival rates were 86% (1 month), 83.9% (6 months), and 81.2% (12 months).
- MT group survival rates were 44.2% (1 month), 36.5% (6 months), and 34.6% (12 months).
- The PPCI group exhibited significantly fewer comorbidities than the MT group. Ventricular fibrillation and ICU admission were noted complications in the PPCI group.
Conclusions:
- PPCI offers a superior survival rate for elderly STEMI patients compared to MT.
- PPCI is associated with a lower comorbidity burden in this patient population.
- These findings support the consideration of PPCI in elderly STEMI patients for improved outcomes.
Objective:
To evaluate the prognosis of primary percutaneous coronary intervention (PPCI) and medical therapy (MT) in elderly patients presenting with ST-elevation myocardial infarction (STEMI).
Methods:
A total of 238 STEMI patients aged above 80 and treated with PPCI (n = 186) and MT (n = 52) at Harefield Hospital, London were included in this study. Patients who did not have true STEMI based on non-diagnostic electrocardiogram (ECG) for STEMI and negative troponin, who presented with left bundle branch block (LBBB) and had normal coronaries were excluded from this study. Primary PCI was defined as any use of a guidewire for more than diagnostic purposes in patients with STEMI, whereas conventional MT was defined as treatment of patients with anti-platelets and anti-thrombotic medications without thrombolysis.
Results:
The survival rate of PPCI patients was 86% (n = 160) at month 1 followed by 83.9% (n = 156) at month 6, and 81.2% (n = 151) at month 12. The survival rate of MT patients was 44.2% (n = 23) at month 1 followed by 36.5% (n = 19) at month 6, and 34.6% (n = 18) at month 12. Compared to MT, significantly fewer comorbidities were found in the PPCI group. Ventricular fibrillation (VF) (4.8%) and consequent admission to intensive care unit (7%) were the major complications of the PPCI group.
Conclusion:
PPCI has a higher survival rate and, compared to MT, fewer comorbidities were observed in the PPCI group of elderly patients presenting with STEMI.
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