Primary angioplasty vs. fibrinolysis in very old patients with acute myocardial infarction: TRIANA (TRatamiento del Infarto Agudo de miocardio eN Ancianos) randomized trial and pooled analysis with previous studies
Why the study?
Does primary percutaneous coronary intervention reduce the composite of all-cause mortality, re-infarction, or disabling stroke at 30 days compared to fibrinolysis in patients ≥75 years old with STEMI <6 h?
Population
266 patients ≥75 years old with ST-segment elevation myocardial infarction (STEMI) <6 h, mean age 81 years.
Comparison
Primary percutaneous coronary intervention (pPCI) vs Fibrinolysis
Design
RCT, Randomized to pPCI or fibrinolysis
Follow-up
30 days
Authors
Discussion
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Implication
pPCI did not significantly reduce the primary composite versus fibrinolysis in elderly STEMI; leaves open optimal reperfusion strategy in this population.
Structured PICO
Does primary percutaneous coronary intervention reduce the composite of all-cause mortality, re-infarction, or disabling stroke at 30 days compared to fibrinolysis in patients ≥75 years old with STEMI <6 h?
P
Population
266 patients ≥75 years old with ST-segment elevation myocardial infarction (STEMI) <6 h, mean age 81 years.
I
Intervention
Primary percutaneous coronary intervention (pPCI)
C
Comparator
Fibrinolysis
O
Outcome
Composite of all-cause mortality, re-infarction, or disabling stroke at 30 dayscomposite
In very old patients with STEMI, pPCI showed a non-significant reduction in the primary composite endpoint compared to fibrinolysis, though a pooled analysis suggested an advantage for pPCI.
Limitations
- Prematurely stopped due to slow recruitment
Cite This Study
Bueno et al. (2010) studied this question.