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PCI for acute heart attack improves outcomes in older patients
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An increased use of PCI in older patients from 2000 to 2016 contributed to a survival benefit at the time of their first acute MI, according to a study published in Circulation: Cardiovascular Interventions.
“We know that PCI is safe, feasible and improves overall survival and well-being in younger adults who have a heart attack, but older adults tend to have more complex medical needs, and live with geriatric syndromes like frailty, multiple chronic conditions, cognitive impairment and use multiple medications,” Abdulla A. Damluji, MD, MPH, assistant professor at Johns Hopkins University School of Medicine and an interventional cardiologist at Sinai Hospital of Baltimore, said in a press release. “Because of these intricacies, they are systematically excluded from clinical trials to test therapies including PCI. As such, the evidence on whether or not such treatment works in older adults has not been fully evaluated.”
Researchers analyzed data from 469,827 patients older than 75 years who were admitted for their first acute MI from 2000 to January 2016. Information obtained from the database included billed services including medications, patient demographics, therapeutic services and diagnostics.
Patients were grouped by age of first acute MI: young-old (aged 75-79 years; n = 157,669), middle-old (aged 80-84 years; n = 143,040) and old-old (aged 85-89 years; n = 169,088).
PCI was performed in 38% of patients in the young-old group, 33% of those in the middle-old group and 20% of patients in the old-old group.
The rate of PCI utilization increased in the young-old and middle-old groups from 2000 to 2016. This contributed to decreased mortality rates in 2016 among patients in the young-old group and the middle-old groups (5% and 7%, respectively). PCI utilization increased from 10% in 2000 to 25% in 2016 among the old-old group with a decline in mortality rates from 17% to 11%.
Compared with the medical therapy group, PCI improved survival rates in the young-old (unadjusted OR = 0.47; 95% CI, 0.45-0.49), middle-old (unadjusted OR = 0.51; 95% CI, 0.5-0.53) and old-old groups (unadjusted OR = 0.58; 95% CI, 0.55-0.6). The highest absolute risk reduction for hospital mortality was seen in patients in the old-old group (54 per 1,000 cases) compared with the young-old (49 per 1,000 cases) and middle-old groups (53 per 1,000 cases). This association persisted after multivariable adjustment within each age group.
“Future investigations are needed to find ways to improve risk stratification and futility of care at older ages,” Damluji and colleagues wrote. – by Darlene Dobkowski
Disclosures: Damluji reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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