Key result
Primary PCI yields similar in-hospital mortality in super-old versus old ACS patients.
Why the study?
Information on the efficacy of primary PCI in super-old patients aged over 90 years with acute myocardial infarction is inadequate.
Does primary percutaneous coronary intervention improve clinical outcomes in super-old patients (≥90 years) with acute coronary syndrome compared to old patients (75-<90 years)?
Cohort (n=454)
Yes
Does primary percutaneous coronary intervention improve clinical outcomes in super-old patients (≥90 years) with acute coronary syndrome compared to old patients (75-<90 years)?
Primary PCI in super-old patients (≥90 years) with ACS is associated with similar in-hospital mortality and post-discharge MACE compared to old patients (75-<90 years), supporting its use in this advanced age group.
Primary PCI linked to lower in-hospital mortality in super-old ACS patients; extends observational data but leaves practice implications open pending prospective confirmation.
BACKGROUND: Current guidelines strongly recommend the application of primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction; however, information on its efficacy in super-old patients aged >90 years is inadequate. We compared the efficacy of primary PCI and its clinical outcomes in super-old patients with those of old patients in a super-aging society. METHODS: Shimane Acute Coronary Syndrome (ACS) Registry was a multicenter retrospective cohort study. Consecutive patients with ACS who visited all PCI centers in Shimane Prefecture between January and December 2020 were enrolled. Patients were classified into four age categories: non-old (<65 years), pre-old (65-<75 years), old (75-<90 years), and super-old (≥90 years). Primary endpoints were major adverse cardiovascular events (MACE), including all-cause death, recurrent ACS, any stroke, and hospitalization for worsening heart failure. RESULTS: In total, 454 patients were enrolled: 99 non-old, 124 pre-old, 181 old, and 50 super-old. The application rate of primary PCI decreased with increased age, with 89 % in old age and 78 % in super-old age (p = 0.042). In-hospital mortality rate was significantly higher in super-old age than in old age (22 % vs. 8 %, p = 0.010), particularly in shock cases (67 % vs. 31 %, p = 0.040); no difference was observed between the two groups in non-shock cases (8 % vs. 4 %, p = 0.259) or in cases that received primary PCI (10 % vs. 6 %, p = 0.232). Landmark analysis revealed that MACE after 30th day did not differ between super-old and old age groups. CONCLUSIONS: In the advanced aging society of Shimane Prefecture, more than half of patients with ACS were aged ≥75 years, with super-old patients aged ≥90 years accounting for 11 % of all patients. In-hospital mortality rate among super-old age patients was lower among those who underwent primary PCI. The prognosis for super-old age patients who were discharged alive was similar to that of old age patients.
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Endo et al. (2024) conducted a cohort in Acute Coronary Syndrome (n=454). Super-old age (≥90 years) vs. Old age (75-<90 years) was evaluated on Major adverse cardiovascular events (MACE), including all-cause death, recurrent ACS, any stroke, and hospitalization for worsening heart failure. In ACS, in-hospital mortality was higher in super-old (≥90 years) vs old (75-<90 years) patients (22% vs 8%, p=0.010), but did not differ among those receiving primary PCI (10% vs 6%, p=0.232).
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