Invasive Strategy With Intended Percutaneous Coronary Intervention Versus Conservative Treatment in Older People With ST‐Segment–Elevation Myocardial Infarction: A Meta‐Analysis

Background Patients ≥80 years old were underrepresented or excluded from landmark trials demonstrating the superiority of primary percutaneous coronary intervention (PCI) in ST‐segment–elevation myocardial infarction. The current meta‐analysis assessed the effects of an invasive strategy with intended PCI compared with conservative treatment in older people (≥80 years) with ST‐segment–elevation myocardial infarction. Methods A structured literature search was performed. The primary outcome was overall survival. Secondary outcome analyses included but were not limited to 30‐day and 1‐year mortality. Results Thirteen studies reporting on 102 158 older adults were included. Of these, 31 629 (31%) were assigned to PCI and 70 529 (69%) were treated conservatively. The overall survival was 76.5% in PCI and 67.2% in conservative treatment at the time of longest available follow‐up (odds ratio [OR], 2.18 [95% CI, 1.79–2.66], P <0.001, I 2 =88%, favoring PCI). The follow‐up period ranged from 30 days to 26.5 months. The 30‐day. (OR, 0.39 [95% CI, 0.31–0.50], P <0.001, I 2 =0%) and 1‐year mortality (OR, 0·34 [95% CI, 0.25–0.46], P <0.001, I 2 =0%), were lower in the PCI group. Conclusions This meta‐analysis indicates a potential underuse of PCI in older adults with ST‐segment–elevation myocardial infarction. PCI was advantageous in short‐ and long‐term survival, but these results were affected by confounding. Nonetheless, every second patient not referred for invasive treatment survived at least 1 year. These findings have hypothesis generating implications, but they indicate ageism and emphasize that PCI should not be automatically withheld in older patients.