Key result
Primary PCI linked to ~45% lower in-hospital composite events in elderly STEMI patients.
Why the study?
Patients with STEMI aged ≥75 years receive less primary PCI than younger patients despite higher in-hospital morbimortality, leaving the effectiveness of primary PCI in this population to be determined.
Does primary percutaneous coronary intervention reduce death, reinfarction, acute pulmonary oedema, or cardiogenic shock during hospitalisation in patients aged ≥75 years with STEMI?
Cohort (n=979)
Yes
Does primary percutaneous coronary intervention reduce death, reinfarction, acute pulmonary oedema, or cardiogenic shock during hospitalisation in patients aged ≥75 years with STEMI?
Odds Ratio: 0.55 (95% CI 0.34–0.89)
p-value: p=0.015
Primary percutaneous coronary intervention is associated with a significantly reduced risk of major in-hospital complications in patients with STEMI aged 75 years or older, reinforcing that advanced age should not be a contraindication to invasive reperfusion.
P-PCI was associated with fewer in-hospital events in elderly STEMI; leaves open whether randomized trials would confirm benefit.
OBJECTIVE: Primary percutaneous coronary intervention (P-PCI) has demonstrated its efficacy in patients with ST segment elevation myocardial infarction (STEMI). However, patients with STEMI ≥75 years receive less P-PCI than younger patients despite their higher in-hospital morbimortality. The objective of this analysis was to determine the effectiveness of P-PCI in patients with STEMI ≥75 years. METHODS: study, a registry of 8142 consecutive patients with acute coronary syndrome admitted at 31 Spanish hospitals in 2014-2016. We calculated a propensity score (PS) for the indication of P-PCI. Patients that received or not P-PCI were matched by PS. Using logistic regression, we compared the effectiveness of performing P-PCI versus non-performance for the composite primary event, which included death, reinfarction, acute pulmonary oedema or cardiogenic shock during hospitalisation. RESULTS: Of the included patients, 81.5 % received P-PCI. The matching provided two groups of 169 patients with and without P-PCI. Compared with its non-performance, P-PCI presented a composite event OR adjusted by PS of 0.55 (95% CI 0.34 to 0.89). CONCLUSIONS: Receiving a P-PCI was significantly associated with a reduced risk of major intrahospital complications in patients with STEMI aged 75 years or older.
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Fernández‐Bergés et al. (2020) conducted a cohort in ST segment elevation myocardial infarction (STEMI) (n=979). Primary percutaneous coronary intervention (P-PCI) vs. No primary percutaneous coronary intervention was evaluated on Composite of death, reinfarction, acute pulmonary oedema or cardiogenic shock during hospitalisation (OR 0.55, 95% CI 0.34-0.89, p=0.015). Primary percutaneous coronary intervention significantly reduced the composite risk of death, reinfarction, acute pulmonary edema, or cardiogenic shock during hospitalization by 45% (OR 0.55) compared with no intervention in STEMI patients aged 75 years or older.
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