Key result
Primary percutaneous coronary intervention for STEMI in elderly patients showed comparable mortality to younger patients, with CKD predicting in-hospital mortality.
Why the study?
Data regarding the safety and efficacy of primary PCI in elderly patients are scarce, and it was unclear whether the advantages of primary PCI diminish with advanced age.
Does primary percutaneous coronary intervention (P-PCI) result in comparable in-hospital and 30-day all-cause mortality in elderly patients (≥75 years) compared to younger patients (65-74 years) with acute STEMI?
Cohort (n=1,111)
Does primary percutaneous coronary intervention (P-PCI) result in comparable in-hospital and 30-day all-cause mortality in elderly patients (≥75 years) compared to younger patients (65-74 years) with acute STEMI?
Primary PCI for acute STEMI in elderly patients (≥75 years) yields comparable in-hospital and 30-day mortality outcomes to younger patients (65-74 years), supporting its use in this population.
Answers are grounded in this paper and cite their sources.
May support P-PCI consideration in elderly STEMI; leaves open randomized confirmation of mortality equivalence.
Background: To date, data regarding safety and efficacy of primary percutaneous coronary intervention (P-PCI) in elderly patients are scarce. We aimed to assess the outcomes of P-PCI in the elderly subgroup, and to evaluate whether the advantages of P-PCI diminish with advanced ages. Methods: This retrospective study included elderly patients who underwent P-PCI for acute STEMI. Patients were sub grouped according to their age into three groups (Group A: aged 75-84, Group B: aged ³85 and control Group C: aged 65-74). The primary endpoint was in-hospital and 30-day all-cause mortality, and secondary endpoints were MACE (death, stroke, MI or re-PCI), stroke, vascular complication, bleeding and transfusion, target vessel re-intervention, contrast induced acute kidney injury (CI-AKI) and gastrointestinal (GI) bleeding. Results: A total of 1111 patients were included with 339 patients in group A, 95 patients in group B and 677 patients in the control group C. In terms of the primary endpoint of our study, no significant difference could be detected between the studied groups. CI-AKI was the only secondary outcome to show a significant difference (P =0.005). Arterial hypertension and a previous history of chronic kidney disease (CKD) were independent predictors of in-hospital mortality, with OR 5.336, 95% CI 1.187 – 23.998 and OR 11.024, 95% CI 2.104 – 57.756, respectively. Additionally, final TIMI flow less than 3 (OR 42.322, 95% CI 5.674 – 315.667) and bleeding that required blood transfusion (OR 87.144, 95% CI 3.086 – 2460.628) showed higher risk of in-hospital MACE. Conclusion: our study revealed that outcomes of P-PCI for STEMI in elderly population (³75) are favourable and comparable to younger patients. Therefore, P-PCI should be offered to every elderly patient presenting with acute STEMI, after considering risk factors for mortality and MACE in this special age group.
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Seif et al. (2022) conducted a cohort in acute STEMI (n=1,111). Primary percutaneous coronary intervention (P-PCI) vs. Patients aged 65-74 years was evaluated on in-hospital and 30-day all-cause mortality. Primary percutaneous coronary intervention for STEMI in elderly patients showed comparable mortality to younger patients, with CKD predicting in-hospital mortality.
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