Effectiveness of primary percutaneous coronary intervention compared with that of thrombolytic therapy in elderly patients with acute myocardial infarction1

Mehta, Rajendra H; Sadiq, Immad; Goldberg, Robert J; Gore, Joel M; Avezum, Álvaro; Spencer, Frederick; Kline-Rogers, Eva; Allegrone, Jeanna; Pieper, Karen; Fox, Keith A.A; Eagle, Kim A; GRACE Investigators,

doi:10.1016/j.ahj.2003.08.007

« Previous Next »American Heart Journal
Volume 147, Issue 2 , Pages 253-259, February 2004

Effectiveness of primary percutaneous coronary intervention compared with that of thrombolytic therapy in elderly patients with acute myocardial infarction¹ ☆

Rajendra H Mehta, MD, MS
- University of Michigan, Ann Arbor, Mich, USA
- Reprint requests: Rajendra H. Mehta, MD, Clinical Assistant Professor of Internal Medicine, 2215 Fuller Rd, 7E, 111A, Ann Arbor, MI 48105, USA.
Immad Sadiq, MD
- University of Massachusetts Medical School, Worcester, Mass, USA
Robert J Goldberg, PhD
- University of Massachusetts Medical School, Worcester, Mass, USA
Joel M Gore, MD
- University of Massachusetts Medical School, Worcester, Mass, USA
Álvaro Avezum, MD
- CTI-A Hospital Albert Einstein, São Paulo, Brazil
Frederick Spencer, MD
- University of Massachusetts Medical School, Worcester, Mass, USA
Eva Kline-Rogers, MS
- University of Michigan, Ann Arbor, Mich, USA
Jeanna Allegrone, BA
- University of Massachusetts Medical School, Worcester, Mass, USA
Karen Pieper, MPH
- Duke Clinical Research Institute, Durham, NC, USA
Keith A.A Fox, MB, ChB, FRCP
- Royal Infirmary of Edinburgh, Edinburgh, UK
Kim A Eagle, MD
- University of Michigan, Ann Arbor, Mich, USA
GRACE Investigators

Received 28 May 2003; accepted 14 August 2003.

Abstract

Background

Few data exist from a community-based perspective on the relative effectiveness of primary percutaneous coronary intervention (PCI) as compared with thrombolytic therapy (TT) in elderly patients with ST-elevation myocardial infarction (STEMI), particularly in the current era of coronary stents and newer antithrombotic agents.

Methods

We evaluated data from patients, aged ≥70 years, with STEMI who were enrolled in the Global Registry of Acute Coronary Events study between April 1999, and September 2002.

Results

Of the 2975 elderly patients eligible for reperfusion therapy, 365 (12.7%) underwent primary PCI and 769 (26.7%) received TT. The median delay from hospital arrival to therapy was 105 minutes for primary PCI and 40 minutes for TT. Inhospital complications for primary PCI versus TT included mortality (13.5% vs 14.8%), reinfarction (1.1% vs 5.7%), composite of death or reinfarction (14.3% vs 18.7%), cardiogenic shock (11.3% vs 11.6%), major bleeding (8.6% vs 5.9%), and stroke (1.1% vs 2.8%). After adjustment for baseline differences and propensity score, patients receiving primary PCI showed a lower rate of reinfarction (odds ratio [OR], 0.15; 95% CI, 0.05–0.44) and mortality (OR, 0.62; 95% CI, 0.39–0.96) and the composite of reinfarction or death (OR, 0.53; 95% CI, 0.35–0.79), with no difference in other outcome measures.

Conclusion

Our data suggest that, compared with TT, primary PCI is associated with a decrease in reinfarction and mortality, with no change in other outcome measures, in elderly patients with STEMI. These findings from an observational registry require further confirmation in future randomized clinical trial assessing the optimal reperfusion strategy in the elderly cohort with STEMI.