Study on Primary PCI in Elderly STEMI Patients

In a recent study conducted in China, researchers explored the prevalence and outcomes of primary percutaneous coronary intervention (PCI) in individuals aged 75 years and older who experienced ST-segment elevation myocardial infarction (STEMI). The research, based on data collected from a multicenter registry between 2013 and 2014, provides insights into the underutilization of primary PCI in Chinese clinical practice and emphasizes its significant potential to improve outcomes in elderly STEMI patients. The study found that patients who received primary PCI exhibited a noteworthy reduction in the risk of two-year all-cause mortality, major adverse cardiac and cerebrovascular events (MACCE), and cardiac death compared to those who did not undergo reperfusion.

The observational study was published in the International Journal of Cardiology Cardiovascular Risk and Prevention.

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Older patients aged ≥75 face high mortality due to age-related comorbidities with ST-segment elevation myocardial infarction (STEMI). Hence, researchers using the China Acute Myocardial Infarction Registry aimed to assess primary PCI prevalence and outcomes in these older patients. Despite guidelines supporting invasive management, the real-world scenario shows declining primary PCI rates with age, raising concerns about disparities between developed and developing countries like China. The research addresses the gap by examining whether primary PCI improves outcomes in older Chinese STEMI patients, including those aged ≥85.

The primary outcome measured was all-cause mortality, and the secondary outcome was major adverse cardiac and cerebrovascular events (MACCE), which included a composite of all-cause mortality, cardiac death, recurrent myocardial infarction (MI), stroke, revascularization, and major bleeding.

Findings:

• Examining a cohort of 999 STEMI patients aged 75 and above, the study found that around 32.9% of these individuals underwent primary PCI.
• Patients who received primary PCI showed a significant reduction in the risk of two-year all-cause mortality, MACCE, and cardiac death compared to those who did not undergo reperfusion.
• Notably, the two-year all-cause mortality rate dropped from 36.4% without reperfusion to 18.0% with primary PCI.
• Similar trends were observed in MACCE (43.5% without reperfusion vs. 28.7% with primary PCI) and cardiac death (23.6% without reperfusion vs. 10.0% with primary PCI).
• Importantly, the study also delved into age-specific nuances, revealing that the positive outcomes associated with primary PCI extended to STEMI patients aged 85 years and older. This underscores the potential benefits of the intervention even in the very elderly population.
• Subgroup analysis further supported the efficacy of primary PCI, demonstrating its superiority in patients with high-risk profiles, such as those experiencing cardiogenic shock or facing delayed hospital admission.

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Notably, no significant differences were observed in recurrent myocardial infarction, stroke, revascularization, and major bleeding between the primary PCI and no reperfusion groups. However, despite these promising results, the study highlighted a concerning trend of underutilization of primary PCI in Chinese clinical practice. Even with its proven benefits in reducing mortality and improving cardiac outcomes, a significant portion of eligible patients did not receive this potentially life-saving intervention.

In conclusion, this comprehensive study underscores the pivotal role of primary PCI in enhancing outcomes for elderly Chinese patients grappling with STEMI. The findings advocate for a paradigm shift in clinical practices, urging healthcare professionals to embrace and implement primary PCI more widely to ensure that elderly individuals receive the optimal care necessary to mitigate the devastating impact of heart attacks.

Further reading: The prevalence and outcomes in STEMI patients aged ≥75 undergoing primary percutaneous coronary intervention in China. Doi: 10.1016/j.ijcrp.2024.200251