Primary invasive treatment with coronary angioplasty significantly improved the 3-year survival rate compared to conservative management in elderly patients with AMI (74.1% vs 29.9%, p<0.001).
Case-Control (n=155)
Does invasive treatment with primary coronary angioplasty improve survival and reduce rehospitalization in elderly patients (≥75 years) with acute myocardial infarction compared to optimal medical therapy alone?
In elderly patients (≥75 years) with acute myocardial infarction, an invasive strategy with primary percutaneous coronary intervention significantly improved 3-year survival and reduced rehospitalization compared to conservative medical therapy alone.
Absolute Event Rate: 74.1% vs 29.9%
p-value: p=<0.001
Abstract Background Elderly patients presenting with acute myocardial infarction (AMI) constitute a particularly vulnerable population due to age-related physiological decline, the presence of multiple comorbidities, and complex coronary anatomy. Although major advances in pharmacotherapy, percutaneous coronary interventions, and reperfusion techniques have markedly improved outcomes in the general AMI population, the optimal management strategy for elderly patients remains a matter of ongoing debate, due to underrepresentation in AMI management trials. Clinical decision-making in this group is often complicated by an increased risk of procedure-related complications, frailty, and the coexistence of chronic diseases that may limit interventional options. Consequently, treatment approaches vary widely across centers, ranging from purely conservative management to early invasive revascularization. Purpose The aim of this study to demonstrate long-term clinical outcomes in elderly patients with AMI who underwent coronary angioplasty versus those managed conservatively, focusing on survival, rehospitalization rates, and major cardiovascular events during a 3-year follow-up period. Methods A total of 155 patients aged 75 years or older admitted with AMI between 2012 and 2017 were included in this retrospective case-control analysis. Among them, 58 patients received invasive treatment with primary coronary angioplasty (Invasive Treatment Group, ITG), while 97 patients received optimal medical therapy alone (Conservative Treatment Group, CTG). Clinical and laboratory parameters, comorbidities, and echocardiographic data were recorded. Long-term survival and rehospitalization rates were analyzed using the Kaplan–Meier method, and intergroup differences were assessed by the log-rank (Mantel–Cox) test. Results The 3-year survival rate was significantly higher in the ITG (74.1%) compared with the CTG (29.9%, p0.001). Mean survival time was also longer in the ITG (31.5 months, 95% CI 29.4–33.7) than in the CTG (24.7 months, 95% CI 22.7–26.6; p0.001). Rehospitalization occurred later and less frequently among patients receiving invasive treatment (p=0.004). Conclusions In elderly patients with acute myocardial infarction, coronary revascularization through percutaneous coronary intervention substantially improves long-term survival and reduces recurrent cardiovascular events compared with conservative management. Despite the potential procedural risks inherent to advanced age, the benefits of invasive treatment appear to outweigh its complications. Careful individual assessment and multidisciplinary decision-making are essential; however, an invasive strategy should be strongly considered as the preferred approach to optimize survival and functional recovery in this high-risk population.
Rapyan et al. (Fri,) conducted a case-control in Acute myocardial infarction (AMI) (n=155). Primary invasive treatment with coronary angioplasty vs. Optimal medical therapy alone (conservative treatment) was evaluated on 3-year survival rate (p=<0.001). Primary invasive treatment with coronary angioplasty significantly improved the 3-year survival rate compared to conservative management in elderly patients with AMI (74.1% vs 29.9%, p<0.001).