Prognosis of PCI in AMI setting in the elderly population: Outcomes from the multicenter prospective e-ULTIMASTER...

Area of Science:

• Cardiology
• Interventional Cardiology
• Geriatric Cardiology

Background:

• Elderly patients with ST-elevation myocardial infarction (STEMI) are often underrepresented in clinical trials for percutaneous coronary intervention (PCI).
• This study addresses the need to evaluate clinical outcomes in this specific patient population.

Purpose of the Study:

• To assess 1-year clinical outcomes after PCI with a drug-eluting stent in patients aged 80 years and older presenting with STEMI.
• To compare outcomes between elderly (≥80 years) and younger (<80 years) STEMI patients.

Main Methods:

• Analysis of data from the e-ULTIMASTER registry, including 7507 patients with STEMI who underwent PCI with the Ultimaster stent.
• Primary endpoint: 1-year target lesion failure (TLF), a composite of cardiac death (CD), target vessel-related myocardial infarction (TV-MI), or clinically driven target lesion revascularization (CD-TLR).
• Comparison of outcomes between 457 elderly patients (≥80 years) and 7050 younger patients (<80 years).

Main Results:

• Elderly patients had more comorbidities and complex coronary anatomy.
• The primary endpoint (TLF) occurred in 7.2% of elderly patients versus 3.1% of younger patients (p < .001).
• All-cause mortality (10.1% vs. 2.3%, p < .0001) and cardiac death (6.1% vs. 1.6%, p < .0001) were significantly higher in the elderly group. No significant difference was observed in TV-MI or CD-TLR rates.

Conclusions:

• Elderly STEMI patients undergoing PCI experienced a higher incidence of target lesion failure and mortality compared to younger patients.
• Despite higher mortality, the rates of target vessel myocardial infarction and target lesion revascularization were similar between age groups.
• Percutaneous coronary intervention for STEMI in elderly patients is considered relatively safe, warranting continued use in this population.