Key result
Primary PCI beats thrombolysis for STEMI patients ≥75 years in trials but lacks registry confirmation.
Why the study?
The specifics of STEMI course in patients aged 75 and older influence the rate and choice of urgent coronary reperfusion, with unclear indications and contraindications for reperfusion in this cohort.
What is the efficacy and safety of different coronary reperfusion methods in patients ≥75 years old with STEMI?
What is the efficacy and safety of different coronary reperfusion methods in patients ≥75 years old with STEMI?
Acute coronary reperfusion is beneficial for STEMI patients ≥75 years old, though the advantage of primary PCI over thrombolysis seen in trials is not fully supported by registry data due to high comorbidity.
Supports reperfusion in elderly STEMI; leaves open whether primary PCI outperforms thrombolysis in comorbid real-world populations.
The review is focused on the main data about course specifics of myocardial infarction with ST elevation (STEMI) in senile patients that influences rate of performing urgent coronary reperfusion. Analysis of literature data has been done, on the topics of efficacy and safety of the main methods of coronary reperfusion — thrombolysis, primary percutaneous intervention (PCI) and their combinations under the pharmacoinvasive reperfusion — in patients ≥75 y.o. As a result of such analysis it is accused that the Open artery theory (Braunwald E.), according which the main task for STEMI patients is acute coronary reperfusion, is truthful not only for general population, but for ≥75 as well. Advantage of primary PCI over thrombolysis in senile patients is shown in randomized trials, but is not proved by registries data. High rate of comorbidity restricts the abilities for reperfusion actions in randomized trials as in real practice. Hence it is important to study further the indications and contraindications for urgent reperfusion in such cohort. Especially it is important for early routine PCI in stable senile patients after thrombolysis, with secondary signs of coronary reperfusion.
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Е. В. Вышлов (2016) conducted a review in ST elevation myocardial infarction (STEMI). Primary percutaneous coronary intervention vs. Thrombolysis was evaluated. Primary percutaneous coronary intervention showed an advantage over thrombolysis in randomized trials of STEMI patients ≥75 years old, though this was not proven by registry data.
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