Angioplasty improves survival in all heart attack patients over 75 years of age
As a person ages, the complexity of coronary disease increases and the operators are faced with a dilemma on whether to perform percutaneous coronary intervention (PCI) or not. Putting an end to this dilemma, a new study published in the journal Circulation: Cardiovascular Interventions has found that PCI improves survival across all age strata of older patients ≥75 with acute myocardial infarction (AMI).
Abdulla Damluji, from the Sinai Hospital of Baltimore, and colleagues conducted the study to evaluate the rate of utilization of PCI during first AMI admission in older patients ≥75 years of age.
The researchers used Premier Healthcare Database that included information of about 750 hospitals in the US. AMI admissions were identified using the primary admission diagnosis and PCI using procedures codes. 469,827 Patients were categorized according to their at first AMI as young-old (75 to 79 years; 34 percent), middle-old (80 to 84 years; 30 percent), and old-old (85 to 89 years; 36 percent).
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They found that:
- PCI was performed in 38, 33, and 20 percent of young-old, middle-old, and old-old groups, respectively.
- From 2000 to 2016, the rate of PCI utilization increased in the young-old and middle-old groups and was paralleled by a decrease in unadjusted mortality rates in later years (mortality rate in 2016: 5 and 7 percent for young-old and middle-old, respectively).
- The rate of PCI utilization increased from 10 to 25 percent for old-old patients with AMI, while the unadjusted mortality rate decreased from 17 to 11 percent.
- PCI was associated with improved survival in all three categories compared with medical therapy.
- PCI use remained associated with a survival benefit in all age strata in multivariable analysis.
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"The results remain valuable to inform physicians treating older patients with AMI, as this group of patients is usually underrepresented in most clinical trials," the authors write.