Invasive versus Conservative Treatment Approach among Older Adult Patients Admitted with Acute ST-Segment Elevation
Keren-Lee Rozenfeld1, Lior Lupu1, Ilan Merdler1
1Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Insights
Primary percutaneous coronary intervention (PCI) significantly improves survival in older adults with ST-elevation myocardial infarction (STEMI). This invasive strategy offers a survival benefit compared to conservative treatment in this vulnerable patient group.
Area of Science:
- Cardiology
- Geriatric Medicine
- Interventional Cardiology
Background:
- ST-elevation myocardial infarction (STEMI) management guidelines prioritize primary percutaneous coronary intervention (PCI).
- The effectiveness and safety of primary PCI in very elderly patients (over 75 years) with STEMI require further investigation.
Purpose of the Study:
- To evaluate the efficacy and safety of primary PCI compared to conservative management in patients over 75 years old diagnosed with acute STEMI.
- To assess 30-day mortality and in-hospital complications in this elderly STEMI population.
Main Methods:
- Retrospective, single-center observational study of 530 patients aged >75 years with STEMI.
- Primary PCI was administered for symptom onset within 12 hours; others received conservative treatment.
- Data on 30-day mortality and hospitalization complications were analyzed.
Main Results:
- Only 5% of patients (28/530) were managed conservatively.
- No significant differences in in-hospital complications like inotropic support or mechanical ventilation were observed between groups.
- The conservative group had a substantially higher risk of 30-day mortality (27% vs. 10%, p=0.02) and a trend towards increased heart failure incidence.
Conclusions:
- Primary PCI in elderly STEMI patients (>75 years) is associated with a significant survival benefit.
- Despite potential safety concerns, primary PCI should be considered a viable treatment strategy for older adults with STEMI.
- The study supports the use of primary PCI in elderly STEMI patients, challenging previous uncertainties about its efficacy in this demographic.
Background:
Primary percutaneous coronary intervention (PCI) is the preferred treatment strategy for patients with ST-elevation myocardial infarction (STEMI); however, its efficacy remains unclear in very older adult patients with STEMI.
Methods:
This retrospective single-center observational study included 530 patients aged >75 years admitted to Tel Aviv Sourasky Medical Center with a diagnosis of acute STEMI. Primary PCI was performed for patients with symptoms ≤12 hours in duration, while the other patients were conservatively treated. We evaluated 30-day mortality and complications occurring during hospitalization based on data from patient records.
Results:
Among the study patients, only 28/530 (5%) were conservatively treated. In-hospital complications, including the use of inotropes or intra-aortic balloon counterpulsation and the need for mechanical ventilation, did not differ significantly between the groups. The only parameter that showed a trend toward significance was the incidence of heart failure during hospitalization (p=0.042). The risk for 30-day mortality was substantially higher in the conservative treatment group than in the invasive treatment group (27% vs. 10%; p = 0.02).
Conclusion:
Our data suggested that despite concerns regarding the safety of the primary PCI strategy in the older adult STEMI population, this treatment strategy was associated with a survival benefit.
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