Prognosis of PCI in AMI setting in the elderly population: Outcomes from the multicenter prospective e‐ULTIMASTER registry

Abstract

Background: Elderly patients with ST-elevation myocardial infarction (STEMI) who undergo percutaneous coronary intervention (PCI) are usually excluded from major trials.Hyopthesis: This study sought to assess 1-year clinical outcomes following PCI with a drug-eluting stent in patients older than 80 years old with STEMI. Methods:The large all-comer, multicontinental e-ULTIMASTER registry included 7507 patients with STEMI who underwent PCI using the Ultimaster stent. The primary clinical endpoint was 1-year target lesion failure, a composite of cardiac death (CD), target vessel-related myocardial infarction (TV-MI), or clinically driven target lesion revascularization (CD-TLR).Results: There were 457 (6.1%) patients in the elderly group (≥80 years old) that were compared to 7050 (93.9%) patients <80 years. The elderly patients included more female patients and had significantly more comorbidities and had more complex coronary anatomy. The primary endpoint occurred in 7.2% of the elderly, compared to 3.1% of the younger group (p < .001). All-cause mortality was significantly higher among the elderly group compared to the younger group (10.1% vs. 2.3%, p < .0001), as well as CD (6.1% vs. 1.6%, p < .0001), but not TV-MI (1.1% vs. 0.7%, p = .34) or CD-TLR (1.1% vs. 1.4%, p = .63). Conclusion:Elderly patients with STEMI presentation had a higher incidence of the composite endpoint than younger patients. All-cause and CD were higher for elderly patients compared to patients younger than 80 years old. However, there was no

Evaluation of myocardial viability by a secondary delayed 99mTc-MIBI nuclear scanning in ST-elevation myocardial infarction patients with delay in referral and nonviable myocardium in the first scintigraphy: a preliminary cohort study

“…If the tissue is still viable, PCI is initiated on the patient; otherwise, current guidelines advise against further revascularization therapy because the tissue has become necrotic [4,6]. Additional therapy for these patients includes the management of post-MI sequelae [4,6,12]. However, collateral vessels represent an alternative source of blood supply to the myocardium in the ischemic area, and after a while, they may help the damaged tissue to resume function; though, this tissue may not be considered viable in the first MPS after MI [13,14].…”

“…If the tissue is still viable, PCI is initiated on the patient; otherwise, current guidelines advise against further revascularization therapy because the tissue has become necrotic [4,6]. Additional therapy for these patients includes the management of post-MI sequelae [4,6,12].…”

“…The most often used nuclear medicine approach in this setting is myocardial perfusion scintigraphy (MPS) with 99mTc-MIBI or Thalium-201 single photon emission computed tomography (SPECT) [9][10][11]. If the tissue is still viable, PCI is initiated on the patient; otherwise, current guidelines advise against further revascularization therapy because the tissue has become necrotic [4,6]. Additional therapy for these patients includes the management of post-MI sequelae [4,6,12].…”

“…As a result, delaying treatment may cause necrosis of the tissue and negatively impact the patient’s prognosis [4,5]. Primary percutaneous coronary intervention (PCI) is the treatment of choice and reduces mortality, particularly from STEMI [4,6,7]. Regardless of myocardial viability, coronary vessels that were occluded less than 24 h ago must be revascularized immediately [4].…”

In-Hospital and Short-Term Outcomes of Percutaneous Coronary Intervention in Patients Older Than 65 Years Old: Results from Tanta PCI Registry

“…In developing countries like Egypt, PCI outcomes in elderly people are more challenging due to several factors such as, lesser awareness about atypical presentation of acute and chronic coronary syndromes in elderly people [6] and limited availability of state-of-the-art equipment.…”