The Comparison of the Outcomes between Primary PCI, Fibrinolysis, and No Reperfusion in Patients ≥ 75 Years Old with ST-Segment Elevation Myocardial Infarction: Results from the Chinese Acute Myocardial Infarction (CAMI) Registry

Abstract

BackgroundOnly a few randomized trials have analyzed the clinical outcomes of elderly ST-segment elevation myocardial infarction (STEMI) patients (≥ 75 years old). Therefore, the best reperfusion strategy has not been well established. An observational study focused on clinical outcomes was performed in this population.MethodsBased on the national registry on STEMI patients, the in-hospital outcomes of elderly patients with different reperfusion strategies were compared. The primary endpoint was defined as death. Secondary endpoints included recurrent myocardial infarction, ischemia driven revascularization, myocardial infarction related complications, and major bleeding. Multivariable regression analysis was performed to adjust for the baseline disparities between the groups.ResultsPatients who had primary percutaneous coronary intervention (PCI) or fibrinolysis were relatively younger. They came to hospital earlier, and had lower risk of death compared with patients who had no reperfusion. The guideline recommended medications were more frequently used in patients with primary PCI during the hospitalization and at discharge. The rates of death were 7.7%, 15.0%, and 19.9% respectively, with primary PCI, fibrinolysis, and no reperfusion (P < 0.001). Patients having primary PCI also had lower rates of heart failure, mechanical complications, and cardiac arrest compared with fibrinolysis and no reperfusion (P < 0.05). The rates of hemorrhage stroke (0.3%, 0.6%, and 0.1%) and other major bleeding (3.0%, 5.0%, and 3.1%) were similar in the primary PCI, fibrinolysis, and no reperfusion group (P > 0.05). In the multivariable regression analysis, primary PCI outweighs no reperfusion in predicting the in-hospital death in patients ≥ 75 years old. However, fibrinolysis does not.ConclusionsEarly reperfusion, especially primary PCI was safe and effective with absolute reduction of mortality compared with no reperfusion. However, certain randomized trials were encouraged to support the conclusion.

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

“…Among the reasons that have traditionally been put forward to exclude those over 75 years of age and that have already been exposed, there is one, 33 which we have not been able to explore, referring to the late arrival at the hospital of the elderly patient ‘outside the optimal window’ for perform a P-PCI. The European Society of Cardiology guidelines 5 established that ‘a routine primary PCI strategy should be considered in patients presenting late (12–48 hours) after symptom onset’.…”

Differences in oxidative metabolism modulation induced by ischemia/reperfusion between trained and untrained individuals assessed by NIRS

“…; Peiyuan et al. ). The abundance of oxygen during reperfusion, combined with the mitochondrial impairment due to the hypoxia, results in an increased ROS production, which in turns causes more apoptosis (Yellon and Hausenloy ).…”

“…Although fundamental in returning to homeostasis after a period of oxygen deprivation, immediate reperfusion can also have some detrimental effects to the cells (Kalogeris et al 2012;Peiyuan et al 2016). The abundance of oxygen during reperfusion, combined with the mitochondrial impairment due to the hypoxia, results in an increased ROS production, which in turns causes more apoptosis (Yellon and Hausenloy 2007).…”

Alterskardiologie

“…B. kontrastmittelindu- ziertes Nierenversagen, lokale Nachblutungen infolge der fragilen Gefäße, respiratorische Insuffizienz bei vorgeschädigtem Lungengewebe). Trotz dieses erhöhten Risikos profitieren auch ältere Menschen von einer modernen Infarktbehandlung mittels PCI, während eine Thrombolyse in der Altersgruppe über 75 Jahre keinen Vorteil bietet [76,77]. Die duale Thrombozytenaggregationshemmung nach Infarkt-PCI ist für 1 Jahr indiziert, auch wenn das Blutungsrisiko bei älteren Patienten erhöht ist [78].…”