title: Comparison of outcomes for patients ≥75 years of age treated with pre-hospital reduced-dose fibrinolysis followed by percutaneous coronary intervention versus percutaneous coronary intervention alone for treatment of ST-elevation myocardial infarction.
abstract: A coordinated system of care for patients with ST-segment elevation myocardial infarctions that includes prehospital administration of reduced-dose fibrinolytic agents coupled with urgent percutaneous coronary intervention (PCI), termed FAST-PCI, has been shown to be at least as effective as primary PCI (PPCI) alone. However, this reduced-dose fibrinolytic strategy could be associated with increased bleeding risk, especially in elderly patients. The purpose of this study was to examine 30-day outcomes in patients aged ≥75 years with ST-segment elevation myocardial infarctions treated with either strategy. Data from 120 patients aged ≥75 years treated with FAST-PCI were compared with those of 94 patients aged ≥75 years treated with PPCI. The primary comparator was mortality at 30 days. Stroke, reinfarction, and major bleeding were also compared. The groups were well matched for age, cardiac risk factors, and ischemic times. At 30 days, mortality was lower with FAST-PCI than with PPCI (4.2% vs 18.1%, p <0.01). Rates of stroke, reinfarction, and major bleeding (4% vs 2%) were similar in the 2 groups. The FAST-PCI cohort had lower rates of cardiogenic shock on hospital arrival (15% vs 26%, p = 0.05) and completely occluded infarct arteries (Thrombolysis In Myocardial Infarction [TIMI] grade 0 flow, 35% vs 61%, p <0.01). In conclusion, for patients aged ≥75 years with ST-segment elevation myocardial infarctions, a FAST-PCI strategy in a coordinated system of care was associated with reduced 30-day mortality, earlier infarct artery patency, and lower incidence of cardiogenic shock at arrival compared with PPCI, without apparent bleeding, stroke, or reinfarction penalties.
authors.affiliation: University of Texas Health Science Center and Memorial Hermann Heart and Vascular Institute, Houston, Texas.
authors.forename: Amirreza
authors.initials: A
authors.lastname: Solhpour
authors.affiliation: University of Texas Health Science Center and Memorial Hermann Heart and Vascular Institute, Houston, Texas.
authors.forename: Kay-Won
authors.initials: KW
authors.lastname: Chang
authors.affiliation: University of Texas Health Science Center and Memorial Hermann Heart and Vascular Institute, Houston, Texas.
authors.forename: Prakash
authors.initials: P
authors.lastname: Balan
authors.affiliation: University of Texas Health Science Center and Memorial Hermann Heart and Vascular Institute, Houston, Texas.
authors.forename: Chunyan
authors.initials: C
authors.lastname: Cai
authors.affiliation: University of Texas Health Science Center and Memorial Hermann Heart and Vascular Institute, Houston, Texas.
authors.forename: Stefano
authors.initials: S
authors.lastname: Sdringola
authors.affiliation: University of Texas Health Science Center and Memorial Hermann Heart and Vascular Institute, Houston, Texas.
authors.forename: Ali E
authors.initials: AE
authors.lastname: Denktas
authors.affiliation: University of Texas Health Science Center and Memorial Hermann Heart and Vascular Institute, Houston, Texas.
authors.forename: Richard W
authors.initials: RW
authors.lastname: Smalling
authors.affiliation: University of Texas Health Science Center and Memorial Hermann Heart and Vascular Institute, Houston, Texas. Electronic address: h.v.anderson@uth.tmc.edu.
authors.forename: H Vernon
authors.initials: HV
authors.lastname: Anderson
mesh_terms: D000368:Aged; D004562:Electrocardiography; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D015912:Thrombolytic Therapy / Q000379:methods*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D005343:Fibrinolytic Agents