Key result
Thrombolytic therapy resulted in similar 1-year mortality compared to primary percutaneous coronary intervention (28.8% vs 17.8%, p=0.184) in STEMI patients aged 65 years and older.
Why the study?
This study aimed to evaluate the effect of primary PCI and thrombolytic therapy on in-hospital adverse events and in-hospital and long-term mortality in patients over 65 years of age with acute STEMI.
Does thrombolytic therapy compared to primary percutaneous coronary intervention improve mortality in elderly patients (over 65 years) with acute STEMI?
Cohort (n=111)
No
Does thrombolytic therapy compared to primary percutaneous coronary intervention improve mortality in elderly patients (over 65 years) with acute STEMI?
In elderly patients with STEMI, thrombolytic therapy and primary PCI showed similar rates of in-hospital, 6-month, and 1-year mortality, suggesting thrombolysis remains a viable option when timely PCI is unavailable.
Answers are grounded in this paper and cite their sources.
Supports thrombolysis when timely PCI unavailable in elderly STEMI; leaves open confirmation of equivalence in randomized trials.
Introduction This study aims to evaluate the effect of primary percutaneous coronary intervention (PCI) and thrombolytic therapy (TT) on the in-hospital adverse events, in-hospital and long-term mortality in patients over 65 years of age with acute ST-segment elevation myocardial infarction (STEMI). Material and methods A total of 111 retrospectively screened patients (73 males, mean age: 73.4 ±5.9 years) over 65 years of age with STEMI, who underwent TT or primary PCI, were included in the study. Patients’ characteristics, in-hospital outcomes, and 6-month and 1-year mortalities were recorded. Results Our study was conducted with 111 patients over 65 years of age with STEMI (73 males, 38 females). Of the patients, 66 (59.5%) were treated with thrombolytics, and 45 (40.5%) patients underwent primary PCI. Door-to-needle time was 25.9 ±7.8 min in the TT group, whereas door-to-balloon time was 84.4 ±20.0 min in the PCI group. Time from symptom onset to hospital admission was 213.6 ±158.4 min in the thrombolytic group, and 166.8 ±112.8 min in the PCI group. Rescue PCI was performed in 7 (10.6%) patients in the TT group due to lack of reperfusion. Recurrent infarction was observed in 5 (7.6%) patients in the TT group and in 2 (4.4%) patients in the PCI group. Non-haemorrhagic stroke was observed in 1 (1.5%) patient in the thrombolytic-administered group and in 4 (8.9%) patients in the PCI group. No intracranial haemorrhage was observed in any patient. Major haemorrhage was observed in 4 (6.1%) patients in the TT group and in 4 (8.9%) patients in the PCI group. Six-month and 1-year mortalities were present in 15 (22.7%) patients and 19 patients in thrombolytic group, and 8 (17.8%) and 8 (17.8%) patients in the PCI group, respectively. Binary logistic regression analysis indicated that the patient’s age was the only predictor for 1-year mortality (odds ratio (OR) = 1.1, 95% confidence interval (CI): 1.019–1.188, p = 0.015). Conclusions Considering the in-hospital adverse outcomes, in-hospital mortality, and 6-month mortality rates, TT and primary PCI have similar effects in STEMI patients aged 65 years and over according to the results of our study. Although 1-year mortality was higher in the TT group, it was not statistically significant.
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Kocayiğit et al. (2019) conducted a cohort in Acute ST-segment elevation myocardial infarction (STEMI) (n=111). Thrombolytic therapy vs. Primary percutaneous coronary intervention (PCI) was evaluated on 1-year mortality (p=0.184). Thrombolytic therapy resulted in similar 1-year mortality compared to primary percutaneous coronary intervention (28.8% vs 17.8%, p=0.184) in STEMI patients aged 65 years and older.
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