Effectiveness of primary percutaneous coronary intervention compared with that of thrombolytic therapy in elderly patients with acute myocardial infarction.
BACKGROUND
Few data exist from a community-based perspective on the relative effectiveness of primary percutaneous coronary intervention (PCI) as compared with thrombolytic therapy (TT) in elderly patients with ST-elevation myocardial infarction (STEMI), particularly in the current era of coronary stents and newer antithrombotic agents.


METHODS
We evaluated data from patients, aged > or =70 years, with STEMI who were enrolled in the Global Registry of Acute Coronary Events study between April 1999, and September 2002.


RESULTS
Of the 2975 elderly patients eligible for reperfusion therapy, 365 (12.7%) underwent primary PCI and 769 (26.7%) received TT. The median delay from hospital arrival to therapy was 105 minutes for primary PCI and 40 minutes for TT. Inhospital complications for primary PCI versus TT included mortality (13.5% vs 14.8%), reinfarction (1.1% vs 5.7%), composite of death or reinfarction (14.3% vs 18.7%), cardiogenic shock (11.3% vs 11.6%), major bleeding (8.6% vs 5.9%), and stroke (1.1% vs 2.8%). After adjustment for baseline differences and propensity score, patients receiving primary PCI showed a lower rate of reinfarction (odds ratio [OR], 0.15; 95% CI, 0.05-0.44) and mortality (OR, 0.62; 95% CI, 0.39-0.96) and the composite of reinfarction or death (OR, 0.53; 95% CI, 0.35-0.79), with no difference in other outcome measures.


CONCLUSIONS
Our data suggest that, compared with TT, primary PCI is associated with a decrease in reinfarction and mortality, with no change in other outcome measures, in elderly patients with STEMI. These findings from an observational registry require further confirmation in future randomized clinical trial assessing the optimal reperfusion strategy in the elderly cohort with STEMI.
Mehta
Rajendra H
RH
University of Michigan, Ann Arbor, Mich, USA. rmehta@umich.edu
Sadiq
Immad
I
Goldberg
Robert J
RJ
Gore
Joel M
JM
Avezum
Alvaro
A
Spencer
Frederick
F
Kline-Rogers
Eva
E
Allegrone
Jeanna
J
Pieper
Karen
K
Fox
Keith A A
KA
Eagle
Kim A
KA
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D004562:Electrocardiography; D006470:Hemorrhage / Q000139:chemically induced / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D009203:Myocardial Infarction / Q000188:drug therapy / Q000401:mortality / Q000517:prevention & control / Q000628:therapy*; D016017:Odds Ratio; D012042:Registries; D055502:Secondary Prevention; D015607:Stents; D013300:Streptokinase / Q000627:therapeutic use; D020521:Stroke / Q000453:epidemiology / Q000209:etiology; D015912:Thrombolytic Therapy / Q000009:adverse effects
D013300:Streptokinase