Key result
Primary percutaneous coronary intervention significantly reduced long-term mortality compared to conservative medical therapy (12.9% vs 40.9%, p=0.02) in nonagenarian patients with acute myocardial infarction.
Why the study?
Does primary percutaneous coronary intervention reduce mortality and improve outcomes compared to medical therapy in nonagenarian patients with STEMI?
Cohort (n=73)
No
Does primary percutaneous coronary intervention reduce mortality and improve outcomes compared to medical therapy in nonagenarian patients with STEMI?
Absolute Event Rate: 12.9% vs 40.9%
p-value: p=0.02
In nonagenarian patients with STEMI, primary PCI is associated with significantly lower long-term mortality compared to conservative medical therapy, despite similar in-hospital mortality.
May support primary PCI in selected nonagenarians with AMI; leaves open need for randomized confirmation before practice change.
Introduction: Although percutaneous coronary intervention is an accepted "first-line" therapy in acute ST elevation myocardial infarction (STEMI) in general population, few data are available on the short- and long-term outcomes of very old patients (age >90 years). Our aim is to evaluate and compare the short and long-term outcomes after primary percutaneous coronary intervention (PPCI) or medical therapy in nonagenarian patients with STEMI. Methods: We retrospectively identified patients older than 90 years old in our clinic, with acute STEMI who presented within 12 hours after symptoms onset, either underwent PPCI or medically treated. In hospital events and long-term results analyzed subsequently. Results: From January 2005 to December 2014, 73 patients with STEMI either underwent PPCI (PPCI group n = 42) or had only medical treatment (Non-PPCI group n = 31). Mean age was 92.4 ± 3.1 (90-106). Patients were followed 26.5 ± 20.1 months. Recurrent myocardial infarction during hospitalization was not observed in both groups. In-hospital mortality, cerebrovascular events and acute renal failure rate were similar between two groups (respectively P = 0.797 and P = 1.000, P = 0.288), whereas arrhythmia was significantly higher in the PPCI group ( 0; 21.4%, P = 0.009). Results show re-infarction was similar in both groups (respectively 3.2%; 11.9%, P = 0.382) but mortality in long-term was significantly lower in the PPCI group (respectively 40.9%; 12.9%, P = 0.02). Conclusion: In nonagenarian patients, with STEMI mortality is very high. Although; in-hospital events were similar, the long-term mortality rate was significantly lower in patients treated with PPCI.
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Şahin et al. (2017) conducted a cohort in Acute ST-elevation myocardial infarction (STEMI) (n=73). Primary percutaneous coronary intervention (PPCI) vs. Conservative medical therapy was evaluated on Long-term (non-hospital) mortality (p=0.02). Primary percutaneous coronary intervention significantly reduced long-term mortality compared to conservative medical therapy (12.9% vs 40.9%, p=0.02) in nonagenarian patients with acute myocardial infarction.
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