Prognosis of very elderly PCI patients better if cardiogenic shock absent
MedWire News: Italian researchers report that nonagenarians with ST-elevation myocardial infarction (STEMI) may benefit from successful percutaneous coronary intervention (PCI) if they do not initially present with cardiogenic shock.
Furthermore, pre-PCI administration of abciximab and successful restoration of thrombolysis in myocardial infarction (TIMI) flow after PCI may improve the 6-month outcomes of these patients.
"Primary PCI is particularly attractive in high-risk patients, and previous studies have shown that the long-term benefit of angioplasty over fibrinolysis is not affected by age," comment Gian Danzi from Ospedale Maggiore Policlinico in Milan, Italy, and team.
"Because the relative risk decrease provided by angioplasty is the same in elderly and younger patients, the absolute benefit [of PCI] may be greater [among the elderly]."
The researchers analyzed the 6-month post-PCI survival rates of 100 nonagenarians (aged at least 90 years). Of these, 35 patients were classified as having a high post-STEMI mortality risk (Killip class III or IV) at baseline.
The findings, reported in the American Journal of Cardiology, show that 19% of patients died in hospital after PCI.
When the team assessed the impact of cardiogenic shock on survival, they found significantly higher in-hospital mortality rates among patients who initially presented with cardiogenic shock (n=19, Killip class IV) than those who did not (n=81), at 58% and 10%, respectively (p<0.001).
In all, 68% of all patients were alive at 6 months post-PCI.
Patients with cardiogenic shock had significantly lower 6-month survival rates than all other patients, at 19% and 84%, respectively (p<0.001). In fact, these patients had a 10.82-fold increase in 6-month mortality compared with all other patients, after accounting for confounders.
Of note, achieving TIMI grade 2 or 3 flow post-PCI (occurred in 91% of patients), and pre-PCI abciximab administration (received by 45% of patients) decreased the risk for 6-month mortality, with hazard ratios of 0.19 and 0.32, respectively, compared with the absence of both factors (p<0.001 and p=0.01, respectively).
The researchers conclude that although their findings provide useful insight into strategies for improving PCI survival in the very elderly, larger studies are required to support these findings.
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By Lauretta Ihonor