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

Daniel Fernández-Bergés, Irene R Degano, Reyes Gonzalez Fernandez, Isaac Subirana, Joan Vila, Manuel Jiménez-Navarro, Silvia Perez-Fernandez, Mercé Roqué, Antoni Bayes-Genis, Francisco Fernandez-Aviles, Antonio Mayorga, Vicente Bertomeu-Gonzalez, Juan Sanchis, Marcos Rodríguez Esteban, Antonio Sanchez-Hidalgo, Esther Sanchez-Insa, Ane Elorriaga, Emad Abu Assi, Alberto Nuñez, Jose Manuel Garcia Ruiz, Pedro Morrondo Valdeolmillos, Daniel Bosch-Portell, Iñaki Lekuona, Andres Carrillo-Lopez, Alberto Zamora, Berta Vega-Hernandez, Javier Alameda Serrano, Catalina Rubert, Luis Ruiz-Valdepeñas, Laura Quintas, Luis Rodríguez-Padial, Jessica Vaquero, Luis Martinez Dolz, Jose A Barrabes, Pedro L Sanchez, Alessandro Sionis, Julio Martí-Almor, Roberto Elosua, Rosa-María Lidon, David Garcia-Dorado, Jaume Marrugat
Open Heart 2020, 7 (2)

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.

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