Primary PCI in nonagenarians lowers death risk after STEMI hospitalization
Primary PCI during an index hospitalization for STEMI in nonagenarians is associated with higher risk for 30‐day readmission but significantly lower mortality rates during the index hospitalization and readmission vs. no PCI, data show.
“Readmissions in nonagenarian STEMI survivors impose a substantial burden on patients and on the U.S. health care system,” Mahmoud Ismayl, MD, an internal medicine resident at CHI Health Creighton University Medical Center in Omaha, Nebraska, told Healio. “Primary PCI during the index hospitalization for STEMI in nonagenarians is associated with slightly higher 30‐day readmissions but significantly lower rates of recurrent MI and mortality during the index hospitalization and readmission.”
In a retrospective study, Ismayl and colleagues analyzed data from 58,231 nonagenarian patients hospitalized with STEMI between 2010 and 2018, using the Nationwide Readmissions Database. The cohort included 32.3% who underwent primary PCI and 67.7% who had no primary PCI. Researchers compared mortality during the index hospitalization and during 30‐day readmission, readmission rates and readmission causes.
The findings were published in Catheterization and Cardiovascular Interventions.
In unadjusted analyses, unplanned 30‐day readmission was higher among patients who underwent a primary PCI vs. those who did not (21% vs. 15.4%; P < .001). However, compared with patients who did not undergo a primary PCI, those who did experienced lower mortality during the index hospitalization (15.8% vs. 32.2%; P < .001) and during 30‐day readmission (7.4% vs. 14.2%; P < .001).
After adjusting for baseline characteristics, hospitalizations that included primary PCI had 25% greater odds for unplanned 30‐day readmission (adjusted OR = 1.25; 95% CI, 1.12-1.39; P < .001) and 49% lower odds for in‐hospital mortality during the index hospitalization (aOR = 0.51; 95% CI, 0.46-0.56; P < .001).
In analyses comparing older vs. younger patients with STEMI, researchers found patients were less likely to undergo PCI if aged 90 years or older vs. patients aged 65 to 69 years (32.3% vs. 71.9%; P < .001)
“Subsequently, in‐hospital mortality and 30‐day readmissions increased for STEMI hospitalizations of older patients,” the researchers wrote. “Compared to no primary PCI, primary PCI was associated with lower in‐hospital mortality across all elderly age groups and lower overall and unplanned readmissions in patients aged 65 to 84 years.”
HF, followed by MI, were the most common causes of readmission for both cohorts.
“This study emphasizes that age is just a number, and that even elderly patients older than age 90 years with STEMI would benefit from primary PCI,” Ismayl told Healio. “Given the marked mortality benefit with primary PCI and increased readmission rates, further research is necessary to optimize utilization of primary PCI while reducing readmission rates following STEMI in nonagenarians.”
For more information:
Mahmoud Ismayl, MD, can be reached at mahmoudismayl1995@hotmail.com; Twitter: @Mahmoud_Ismayl.
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