Benefit of primary percutaneous coronary interventions in the elderly with ST segment elevation myocardial infarction

Fernández-Bergés, Daniel; Dégano, Irene R.; Subirana Cachinero, Isaac; Martí-Almor, Julio; Vila, Joan; Pérez-Fernández, Silvia; Elosua Llanos, Roberto; Marrugat de la Iglesia, Jaume; ATHOS investigators

doi:http://dx.doi.org/10.1136/openhrt-2019-001169

Benefit of primary percutaneous coronary interventions in the elderly with ST segment elevation myocardial infarction

Llicència

Citació

Fernández-Bergés D, Degano IR, Gonzalez Fernandez R, Subirana I, Vila J, Jiménez-Navarro M, et al. Benefit of primary percutaneous coronary interventions in the elderly with ST segment elevation myocardial infarction. Open Heart. 2020 Aug; 7(2): e001169. DOI: 10.1136/openhrt-2019-001169

Resum

Objective: Primary percutaneous coronary intervention (P-PCI) has demonstrated its efficacy in patients with ST segment elevation myocardial infarction (STEMI). However, patients with STEMI ≥75 years receive less P-PCI than younger patients despite their higher in-hospital morbimortality. The objective of this analysis was to determine the effectiveness of P-PCI in patients with STEMI ≥75 years. Methods: We included 979 patients with STEMI ≥75 years, from the ATención HOspitalaria del Síndrome coronario study, a registry of 8142 consecutive patients with acute coronary syndrome admitted at 31 Spanish hospitals in 2014-2016. We calculated a propensity score (PS) for the indication of P-PCI. Patients that received or not P-PCI were matched by PS. Using logistic regression, we compared the effectiveness of performing P-PCI versus non-performance for the composite primary event, which included death, reinfarction, acute pulmonary oedema or cardiogenic shock during hospitalisation. Results: Of the included patients, 81.5 % received P-PCI. The matching provided two groups of 169 patients with and without P-PCI. Compared with its non-performance, P-PCI presented a composite event OR adjusted by PS of 0.55 (95% CI 0.34 to 0.89). Conclusions: Receiving a P-PCI was significantly associated with a reduced risk of major intrahospital complications in patients with STEMI aged 75 years or older.