Key result
Invasive therapy was associated with a significantly lower 28-day case fatality compared to non-invasive therapy across all age groups, including an OR of 0.39 in patients aged 75-84 years.
Why the study?
Does invasive therapy reduce 28-day-case fatality compared to non-invasive therapy in patients with acute myocardial infarction across different age groups?
Observational (n=3,475)
Does invasive therapy reduce 28-day-case fatality compared to non-invasive therapy in patients with acute myocardial infarction across different age groups?
Odds Ratio: 0.39 (95% CI 0.24–0.63)
Absolute Event Rate: 9.4% vs 19.5%
p-value: p=<0.0001
Invasive therapy for acute myocardial infarction is associated with significantly reduced 28-day mortality across all age groups, though elderly patients and those with NSTEMI or comorbidities are less likely to receive it.
Should not yet change AMI practice; leaves open need for RCTs to address selection bias in elderly patients.
BACKGROUND: A substantial proportion of patients with acute myocardial infarction (AMI) did not receive invasive therapy, defined as percutaneous coronary intervention and/or coronary artery bypass grafting. Aims of this study were to evaluate predictors of non-invasive therapy in elderly compared to younger AMI patients and to assess the association between invasive therapy and 28-day-case fatality. METHODS: From the German population-based registry, 3475 persons, consecutively hospitalized with an AMI between 2009 and 2012 were included. Data were collected by standardized interviews and chart review. All-cause mortality was assessed on a regular basis. Multivariable logistic regression analyses were conducted. RESULTS: The sample consisted of 1329 patients aged 28-65 years (age category [AC] 1), 1083 aged 65-74 years (AC 2), and 1063 aged 75-84 years (AC 3). The proportion of patients receiving non-invasive therapy was 10.7, 17.7, and 35.8 % in AC 1, 2, and 3, respectively. Predictors of non-invasive therapy in all ACs were non-ST segment elevation MI, bundle branch block, reduced left ventricular ejection fraction, prior stroke, absence of hyperlipidemia, and low creatine kinase. Elderly women (≥65 years) were less likely to receive invasive therapy. Stratifying the models by type of AMI revealed fewer predictors in patients with ST segment elevation MI. Regarding 28-day-case fatality, strong inverse relations with invasive therapy were seen in all AC: odds ratio of 0.35 (95 % confidence interval [CI] 0.15-0.84), 0.45 (95 % CI 0.22-0.92), and 0.39 (95 % CI 0.24-0.63) in AC 1, 2 and 3, respectively. CONCLUSION: In today's real-life patient care we found that predictors of non-invasive therapy were predominantly the same in all age groups, but differed particularly by type of AMI. Further research is necessary to investigate the real reasons for non-invasive therapy, especially among elderly women. Moreover, we confirmed that receiving invasive therapy was inversely associated with 28-day-case fatality independent of age.
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Amann et al. (2016) conducted an observational in Acute myocardial infarction (n=3,475). Invasive therapy (PCI or CABG) vs. Non-invasive (conservative) therapy was evaluated on 28-day-case fatality (patients aged 75-84 years) (OR 0.39, 95% CI 0.24-0.63, p=<0.0001). Invasive therapy was associated with a significantly lower 28-day case fatality compared to non-invasive therapy across all age groups, including an OR of 0.39 in patients aged 75-84 years.
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