Outcomes of primary percutaneous coronary intervention for acute ST-elevation myocardial infarction in patients aged over 75 years.
BACKGROUND
The optimal reperfusion strategy in elderly patients with ST-elevation myocardial infarction (STEMI) remains unclear. The purpose of this study was to evaluate the safety, in-hospital and one-year clinical outcomes for patients > 75 years of age with STEMI receiving primary percutaneous coronary intervention (PCI), compared with those treated by conservative approach.


METHODS
One hundred and two patients > 75 years of age with STEMI presented < 12 hours were randomly allocated to primary PCI (n = 50) or conservative therapy only (n = 52). The baseline characteristics, in-hospital outcome and major adverse cardiac events (MACE), including death, non-fatal myocardial infarction and target vessel revascularization at one-year clinical follow-up were compared between the two groups.


RESULTS
Age, gender distribution, risk factors for coronary artery disease, infarct site and clinical functional status were similar between the two groups, but the patients in primary PCI group received less low-molecular-weight heparin during hospitalization. Compared with conservative group, the patients in primary PCI group had significantly lower occurrence rate of re-infarction and death and shortened hospital stay. The composite endpoint for in-hospital survivals at 30-day follow-up was similar between the two groups, but one-year MACE rate was significantly lower in the primary PCI group (21.3% and 45.2%, P = 0.029). Left ventricular ejection fraction was not significantly changed in both groups during follow-up. Multivariate analysis revealed that primary PCI (OR = 0.34, 95% CI: 0.21 - 0.69, P = 0.03) improved MACE-free survival rate for STEMI patients aged > 75 years.


CONCLUSIONS
Our results indicated that primary PCI was safe and effective in reducing in-hospital mortality and one-year MACE rate for elderly patients with STEMI.
Zhang
Qi
Q
Department of Cardiology, Shanghai Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200025, China.
Zhang
Rui-yan
RY
Zhang
Jian-sheng
JS
Hu
Jian
J
Yang
Zhen-kun
ZK
Zheng
Ai-fang
AF
Zhang
Xian
X
Shen
Wei-feng
WF
D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D009204:Myocardial Revascularization; D015607:Stents