Successful PCI in octo- and nonagenarians with STEMI led to the greatest absolute 30-day mortality risk reduction, with a number-to-treat of 5.6.
Does successful primary PCI improve mortality in octogenarians and nonagenarians with STEMI?
Octogenarians and nonagenarians with STEMI represent an increasing proportion of cases and derive the greatest absolute mortality benefit from successful primary PCI despite higher rates of cardiogenic shock and atypical presentations.
Abstract Introduction Due to demographic changes, elderly represent a patient group of increasing importance. However, this patient group is often underrepresented in clinical trials. Aim of the present study was to investigate, how incidence rates, infarction severity and treatment strategies of ST-elevation-myocardial infarctions (STEMI) in octogenarians and nonagenarians have changed during the last two decades and to assess how gender and interventional results influenced prognosis. Methods All patients admitted with STEMI to a large PCI-center between 2006 and 2022 were analysed and stratified by age. Univariate comparisons were complemented with multivariate models adjusted for confounders. Results Of a total of 12088 STEMI-patients, 1703 (14.1 %) were octo- or nonagenarians. The relative proportion of patients ≥80 yrs. of age increased from 12.5% 2006-2007 to 16.8% in 2020-2022; p0.01. The absolute number of admissions/month increased from 7.9 STEMIs/month in 2006-2007 to 11.2 STEMIs/month in 2020-2022. At the same time, patients ≥80 yrs. of age were more likely to present with STEMI complicated by cardiogenic shock (2006-2007: 15.1% to 2020-2022: 19.4 %; p(for trend)0.01) and to be treated with primary percutaneous coronary intervention (PCI): 2006-2007: 72.5% to 2020-2022: 91.2%; p(for trend)0.01. Of all patients, 918 (53.9%) were women and 785 (46.1%) men. When comparing elderly women to men, rates of cardiogenic shock were similar (16.8% vs. 18.1 %, p=0.51) as were rates of primary PCI (87.3% vs. 87.1 %, p=0.92). However, rates of absence of typical chest pain were higher in women compared to men (18.5% vs. 12.9%, p0.01). Furthermore, women showed a higher 30-day-mortality (29.4% vs. 24.3%, p=0.035) and a trend towards a higher 1 year-mortality (41.7% vs. 36.9%, p=0.06). 5-year-mortality rates were again similar between genders (63.5% vs. 63.6%, p=0.9). When focusing on the entire cohort and comparing the impact of a successful PCI by age group, it could be shown that the beneficial impact of a successful PCI with a TIMI-3-flow was independent of age and other confounders and that the greatest absolute risk reduction (ARR) in 30-day-mortality could be seen for octogenarians or nonagenarians (table). Conclusions This registry data shows that during the last 17 years, STEMI-numbers in patients ≥80 years increased by 42% with higher rates of concomitant cardiogenic shock. While elderly women compared to men showed a worse 30 day and 1 year outcome, 5-year-mortality rates were similar between genders. Compared to younger patient cohorts octo- and nonagenarians with STEMI showed the greatest absolute benefit form a successful PCI resulting in a number-to-treat of 5.6.Table:30 day mort. by age group
Schmucker et al. (2025) studied this question. Successful PCI in octo- and nonagenarians with STEMI led to the greatest absolute 30-day mortality risk reduction, with a number-to-treat of 5.6.