The prevalence and outcomes in STEMI patients aged ≥75 undergoing primary percutaneous coronary intervention in China
Mengjin Hu1, Xinyue Lang2, Jingang Yang2
1Xuanwu Hospital, Capital Medical University, Beijing 100053, China.
Insights
Primary percutaneous coronary intervention (PCI) significantly reduces mortality and major adverse events in elderly ST-segment elevation myocardial infarction (STEMI) patients. This effective treatment remains underutilized in Chinese practice.
Area of Science:
- Cardiology
- Geriatric Medicine
- Interventional Cardiology
Background:
- ST-segment elevation myocardial infarction (STEMI) in elderly patients (≥75 years) presents unique challenges.
- Optimal reperfusion strategies for this demographic are crucial for improving outcomes.
- Limited data exists on the effectiveness of primary percutaneous coronary intervention (PCI) in older Chinese populations.
Purpose of the Study:
- To evaluate the prevalence and outcomes of primary PCI in Chinese STEMI patients aged 75 years and older.
- To compare the efficacy of primary PCI versus no reperfusion in this high-risk group.
- To identify factors influencing treatment decisions and outcomes in elderly STEMI patients.
Main Methods:
- A multicenter registry identified STEMI patients aged ≥75 years between 2013 and 2014.
- Primary outcome was all-cause mortality; secondary outcome was major adverse cardiac and cerebrovascular event (MACCE).
- Hazard ratios (HR) and 95% confidence intervals (CI) were calculated to assess treatment effects.
Main Results:
- Primary PCI was utilized in 32.9% of eligible patients.
- Primary PCI was associated with significantly lower two-year all-cause mortality (18.0% vs. 36.4%) and MACCE (28.7% vs. 43.5%) compared to no reperfusion.
- These benefits extended to patients aged ≥85 years, those with cardiogenic shock, or delayed hospital admission.
Conclusions:
- Primary PCI demonstrates significant benefits in reducing mortality and MACCE for elderly STEMI patients, including the very old and high-risk subgroups.
- Despite its efficacy, primary PCI is underutilized in Chinese clinical practice for this patient population.
- Further efforts are needed to promote the adoption of primary PCI in elderly STEMI patients in China.
Objective:
To investigate the prevalence and outcomes of primary percutaneous coronary intervention (PCI) in Chinese patients with ST-segment elevation myocardial infarction (STEMI) aged ≥75 years.
Methods:
We identified STEMI patients aged ≥75 years between 2013 and 2014 from a multicenter registry. The primary outcome was all-cause mortality. The secondary outcome was major adverse cardiac and cerebrovascular event (MACCE) including a composite of all-cause mortality, cardiac death, recurrent MI, stroke, revascularization, and major bleeding. Hazard ratios (HR) and associated 95% confidence interval (CI) were calculated.
Results:
Approximately 32.9% (n = 999) patients received primary PCI. Primary PCI was associated with lower risks of two-year all-cause mortality (18.0% vs. 36.4%; adjusted HR: 0.54, 95% CI: 0.45 to 0.65, P < 0.0001), MACCE (28.7% vs. 43.5%; adjusted HR: 0.68, 95% CI: 0.59 to 0.80, P < 0.0001), and cardiac death (10.0% vs. 23.6%; adjusted HR: 0.49, 95% CI: 0.38 to 0.62, P < 0.0001) relative to no reperfusion (n = 2041) in patients aged ≥75 years. The better outcomes in two-year all-cause mortality, MACCE, and cardiac death were consistently observed in STEMI patients aged ≥85 years. No differences were observed in recurrent MI, stroke, revascularization, and major bleeding between the two groups. Additionally, in patients with relatively high-risk profiles such as cardiogenic shock or delaying hospital admission, primary PCI was also superior to no reperfusion.
Conclusion:
Primary PCI may decrease two-year all-cause mortality, MACCE, and cardiac death in STEMI patients aged ≥75 years, even in these with age ≥85 years, cardiogenic shock, or delaying hospital admission. However, primary PCI was underutilized in Chinese clinical practice.
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