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Updated: Jan 25, 2026
Primary Outcome Assessment in a Pig Model of Acute Myocardial Infarction
Published on: October 14, 2016
Primary Percutaneous Coronary Intervention in Elderly Patients With Acute Myocardial Infarction - An Analysis From a
Shiro Uemura1, Hiroshi Okamoto1, Michikazu Nakai2
1Cardiovascular Medicine, Kawasaki Medical School.
Insights
Primary percutaneous coronary intervention (pPCI) is underutilized in elderly acute myocardial infarction (AMI) patients. However, pPCI improves outcomes and reduces mortality in this population, supporting its broader application.
Area of Science:
- Cardiology
- Geriatric Medicine
- Interventional Cardiology
Background:
- Primary percutaneous coronary intervention (pPCI) is recommended for acute myocardial infarction (AMI).
- Its application and effectiveness in elderly patients (≥75 years) remain less clear.
- Elderly patients represent a significant portion of AMI cases.
Purpose of the Study:
- To investigate the utilization and outcomes of pPCI in elderly AMI patients.
- To identify predictors of pPCI non-application in this demographic.
- To evaluate the association between pPCI and 30-day mortality in elderly AMI patients.
Main Methods:
- Analysis of a Japanese nationwide registry (JROAD-DPC) from 2012-2015.
- Inclusion of 115,407 AMI patients, with 45,645 categorized as elderly (≥75 years).
- Comparison of pPCI rates, clinical outcomes, and mortality between elderly and younger patients; propensity score-matching analysis.
Main Results:
- Elderly patients received pPCI less frequently (62.2%) than younger patients (79.2%).
- Higher age, female sex, higher Killip class, and renal dysfunction predicted non-application of pPCI.
- pPCI was independently associated with lower 30-day mortality in patients aged ≥60 years, including elderly patients, and reduced hospitalization duration and improved functional ability at discharge.
Conclusions:
- Despite lower utilization, pPCI is associated with improved clinical outcomes in elderly AMI patients.
- Findings support the proactive application of pPCI for eligible elderly AMI patients.
- pPCI demonstrates a consistent benefit in reducing mortality and improving recovery in older adults with AMI.
Background:
Primary percutaneous coronary intervention (pPCI) is strongly recommended by guidelines for patients presenting with acute myocardial infarction (AMI), but its applications in elderly patients are less clear.
Methods And Results:
The JROAD-DPC is a Japanese nationwide registry for patients with cardiovascular diseases combined with an administrative claim-based database. Among 2,369,165 records from 2012 to 2015, data for 115,407 AMI patients were extracted for this study. Elderly patients (≥75 years) comprised 45,645 subjects (39.6%), and received pPCI less frequently (62.2%) than younger patients (79.2%, P<0.001). Clinical variables such as higher age, female sex, higher Killip class, and renal dysfunction, but not functional status on admission, were predictors of non-application of pPCI. Endpoint 30-day mortality increased with aging, and was significantly higher in elderly patients (10.7%) than in younger patients (3.8%, P<0.001). Indeed, pPCI was independently associated with lower 30-day mortality only in subgroups of patients aged ≥60 years. Propensity score-matching analysis confirmed a similar reduction in endpoint 30-day mortality with pPCI in elderly patients. Duration of hospitalization was significantly shorter and functional ability on discharge was significantly better in elderly patients who underwent pPCI.
Conclusions:
Elderly patients with AMI underwent pPCI less frequently, but it was consistently associated with better clinical outcome in these patients. Our findings support the proactive application of pPCI for elderly AMI patients when they are eligible for an invasive strategy.
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