Invasive therapy benefits elderly AMI patients
MedWire News: Results from a large Polish study indicate that invasive treatment of acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) in patients aged 75 years or older reduces 6-month mortality risk compared with noninvasive treatment.
The study authors also observed a significant reduction in in-hospital mortality rates among these invasively treated patients. This, they say, "suggests that the early [in-hospital] survival benefit establishes longer term survival rather than prolonging eventual demise."
In the study, Mariusz Gasior (Medical University of Silesia, Zabrze, Poland) and colleagues assessed in-hospital and 6-month mortality rates among 1976 patients aged at least 75 years, and admitted for AMI with CS.
Of these, 509 (26%) were treated invasively by percutaneous coronary intervention or coronary artery bypass grafting, and 1467 (74%) were treated noninvasively using pharmacotherapy.
Writing in the American Journal of Cardiology, Gasior and team report lower in-hospital mortality rates among patients who received invasive therapy compared with those who received noninvasive therapy, at 55.4% and 69.9%, respectively (p<0.0001).
Other in-hospital outcomes, namely stroke and reinfarction, occurred at similar rates in both patient groups. In-hospital major bleeding, however, occurred more frequently among invasive-treatment patients, at a rate of 3.7%, than in those who received noninvasive therapy, at 1.3% (p<0.001).
At the end of a 6-month follow-up period, Gasior and colleagues also found a lower mortality rate of 65.8% among invasive-therapy patients compared with 80.5% among those in the noninvasive group, (p<0.0001).
Furthermore, propensity score analysis showed that even after adjustment for multiple confounding factors, such as age, gender, and previous AMI, invasive treatment remained associated with significantly lower in-hospital and 6-month mortality rates compared with noninvasive treatment.
The researchers say that they hope their findings help to address some of the "controversies concerning the optimal treatment of elderly patients with acute myocardial infarctions (AMIs) complicated by cardiogenic shock."
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By Lauretta Ihonor