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October 5, 2011Catheterization and Cardiovascular Interventions

Primary percutaneous coronary intervention for acute myocardial infarction in the elderly aged ≥75 years

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Key result

Primary percutaneous coronary intervention in STEMI patients showed that age ≥75 years was not an independent predictor of 30-day mortality (OR 1.00; 95% CI 0.41-2.41; P=0.99).

Why the study?

Does successful primary percutaneous coronary intervention improve 30-day mortality in elderly patients (≥75 years) with STEMI compared to unsuccessful PCI and younger patients?

Population

947 consecutive patients with ST-segment elevation myocardial infarction treated with primary percutaneous…

Comparison

Primary percutaneous coronary intervention with… vs Younger patients treated with primary PCI, and…

Design

Cohort

Follow-up

30-day

Authors

KSKoyu SakaiSNShinya NagayamaKIKasumi Ihara

Discussion

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Overview

Supports primary PCI in elderly STEMI without independent age-related mortality risk; leaves open randomized confirmation of reperfusion benefits.

Key Points

  • To determine whether primary percutaneous coronary intervention provides clinical survival benefits in patients aged 75 years and older presenting with ST-segment elevation myocardial infarction.
  • Reviewed a consecutive cohort of 947 patients treated with primary PCI for STEMI, divided into older (≥75 years, N=331) and younger (<75 years, N=616) cohorts.
  • Evaluated procedural success, door-to-balloon intervals, pre-existing comorbidities, and 30-day all-cause and cardiac mortality using multivariate logistic regression.
  • Older patients had higher overall 30-day mortality (7.6% vs. 3.9%, P=0.015) and cardiac mortality (6.6% vs. 3.7%, P=0.045) than younger patients, despite similar successful reperfusion rates (90.0% vs. 92.7%, P=0.16).
  • Successful PCI significantly decreased 30-day mortality compared with unsuccessful PCI in both older patients (6.0% vs. 21%, P=0.0018) and younger patients (2.8% vs. 18%, P<0.0001).
  • Multivariate analysis showed unsuccessful reperfusion independently predicted 30-day mortality (odds ratio [OR], 4.04; 95% CI, 1.79–9.12; P=0.0008), whereas age ≥75 years (OR, 1.00; 95% CI, 0.41–2.41; P=0.99) did not.

Study Design

Type

Cohort (n=947)

Structured PICO

Does successful primary percutaneous coronary intervention improve 30-day mortality in elderly patients (≥75 years) with STEMI compared to unsuccessful PCI and younger patients?

P
Population
947 consecutive patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI), including 331 aged ≥75 years (older) and 616 aged <75 years (younger).
I
Intervention
Primary percutaneous coronary intervention (PCI) with successful reperfusion
C
Comparator
Younger patients (<75 years) treated with primary PCI, and patients with unsuccessful PCI
O
Outcome
30-day mortality ratehard clinical

Main Result

Absolute Event Rate: 7.6% vs 3.9%

p-value: p=0.015

Successful primary PCI significantly reduces 30-day mortality in STEMI patients aged ≥75 years, with outcomes comparable to younger patients when reperfusion is successful.

Cite This Study

Sakai et al. (2011) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) (n=947). Primary percutaneous coronary intervention vs. Age <75 years was evaluated on 30-day mortality (p=0.015). Primary percutaneous coronary intervention in STEMI patients showed that age ≥75 years was not an independent predictor of 30-day mortality (OR 1.00; 95% CI 0.41-2.41; P=0.99).

synapsesocial.com/papers/6a0f34fa68065d64b26c91e1https://doi.org/10.1002/ccd.22810
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Also Consider

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