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Mortality increases with age in patients with AMI treated with PCI

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NEW ORLEANS — The use of PCI to treat patients with acute myocardial infarction and cardiogenic shock is associated with high procedural success rates and low risk for bleeding, regardless of age, according to findings presented at the American Heart Association Scientific Sessions.

The rate of mortality was associated with a patient’s age, according to the researchers.

Using data from the German ALKK-PCI registry, Uwe Zeymer, MD, of Klinikum Ludwigshafen in Germany, and colleagues analyzed 2,323 patients with acute myocardial infarction and cardiogenic shock treated with PCI across 47 hospitals between 2009 and 2014.

The researchers aimed to determine the impact of age on procedural and clinical outcomes in patients with cardiogenic shock.

Patients were divided into four subgroups based on age. The researchers identified patients as aged less than 65 years (n = 887); aged 65 to 74 years (n = 673), 75 to 84 years (n = 604), and aged 85 years or older (n = 159).

Patients aged 85 years or older had the most women (56%) of all the subgroups.

Forty-three percent of patients aged less than 65 years had triple-vessel disease. The rate of the disease increased in each patient population.

Eighty-four percent of patients aged less than 65 years had a TIMI score of 3 after PCI. The remaining subgroups had lower rates of TIMI score of 3, with the oldest subgroup having the lowest occurrence (78%).

A TIMI score of ≤ 1was similar between each subgroup (10%-12%).

The rate of mortality steadily increased in each subgroup as age increased. Patients aged less than 65 years had a mortality rate of 32%. Mortality rose to 46% in patients aged 65 to 74 years and 49% in patients aged 75 to 84 years. The oldest subgroup had the highest mortality rate (56%).

However, bleeding rates were significantly low in each subgroup with minimal difference between each group. Patients aged 75-84 years had the lowest bleeding rate (2%), while the oldest subgroup had the highest (2.3%).

“If we are successful – even in the very elderly … if somebody is 85 and has been in good shape, it is worthwhile to try PCI,” Zeymer said during the presentation. “If you are successful, then the prognosis of such a patient is not that bad. Otherwise, if we do nothing, they will die in almost 100% of the cases.” – by Ryan McDonald

Reference:

Zeymer U, et al. IN.AOS.855 - Hot Trials in Interventional Cardiology. Presented at: American Heart Association Scientific Sessions; Nov. 12-16, 2016; New Orleans.

Disclosure: Zeymer reports serving on the speaker’s bureau for AstraZeneca, Boehringer Ingelheim, Bayer, Bristol-Meyers Squibb and Daiichi Sankyo.