Benefit of primary percutaneous coronary interventions in the elderly with ST segment elevation myocardial infarction
Daniel Fernández-Bergés1,2, Irene R Degano3, Reyes Gonzalez Fernandez4
1Unidad de Investigación, Hospital Don Benito-Villanueva, Don Benito, Spain polonibo@gmail.com.
Insights
Primary percutaneous coronary intervention (P-PCI) reduces major complications in elderly ST-segment elevation myocardial infarction (STEMI) patients. This study confirms P-PCI
Area of Science:
- Cardiology
- Interventional Cardiology
- Geriatric Medicine
Background:
- Primary percutaneous coronary intervention (P-PCI) is effective for ST-segment elevation myocardial infarction (STEMI).
- Elderly patients (≥75 years) with STEMI experience higher in-hospital mortality but receive P-PCI less frequently.
Purpose of the Study:
- To evaluate the effectiveness of P-PCI in STEMI patients aged 75 years and older.
Main Methods:
- Analysis of 979 STEMI patients ≥75 years from the ATENCIÓN HOspitalaria del Síndrome coronario registry (2014-2016).
- Propensity score matching was used to compare patients who received P-PCI versus those who did not.
- Logistic regression analyzed the composite endpoint of death, reinfarction, pulmonary edema, or cardiogenic shock.
Main Results:
- 81.5% of eligible patients received P-PCI.
- After propensity score matching, P-PCI was associated with a significantly reduced risk of the composite endpoint (OR 0.55; 95% CI 0.34-0.89).
Conclusions:
- P-PCI is associated with significantly reduced major in-hospital complications in elderly STEMI patients (≥75 years).
- This finding supports the consideration of P-PCI in older STEMI populations.
Objective:
Primary percutaneous coronary intervention (P-PCI) has demonstrated its efficacy in patients with ST segment elevation myocardial infarction (STEMI). However, patients with STEMI ≥75 years receive less P-PCI than younger patients despite their higher in-hospital morbimortality. The objective of this analysis was to determine the effectiveness of P-PCI in patients with STEMI ≥75 years.
Methods:
We included 979 patients with STEMI ≥75 years, from the ATención HOspitalaria del Síndrome coronario study, a registry of 8142 consecutive patients with acute coronary syndrome admitted at 31 Spanish hospitals in 2014-2016. We calculated a propensity score (PS) for the indication of P-PCI. Patients that received or not P-PCI were matched by PS. Using logistic regression, we compared the effectiveness of performing P-PCI versus non-performance for the composite primary event, which included death, reinfarction, acute pulmonary oedema or cardiogenic shock during hospitalisation.
Results:
Of the included patients, 81.5 % received P-PCI. The matching provided two groups of 169 patients with and without P-PCI. Compared with its non-performance, P-PCI presented a composite event OR adjusted by PS of 0.55 (95% CI 0.34 to 0.89).
Conclusions:
Receiving a P-PCI was significantly associated with a reduced risk of major intrahospital complications in patients with STEMI aged 75 years or older.
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