Invasive versus Conservative Treatment Approach among Older Adult Patients Admitted with Acute ST-Segment Elevation Myocardial Infarction

다국어 초록 (Multilingual Abstract)

Background: Primary percutaneous coronary intervention (PCI) is the preferred treatment strategy for patients with ST-elevation myocardial infarction (STEMI); however, its efficacy remains unclear in very older adult patients with STEMI. Methods: This retrospective single-center observational study included 530 patients aged >75 years admitted to Tel Aviv Sourasky Medical Center with a diagnosis of acute STEMI. Primary PCI was performed for patients with symptoms ≤12 hours in duration, while the other patients were conservatively treated. We evaluated 30-day mortality and complications occurring during hospitalization based on data from patient records. Results: Among the study patients, only 28/530 (5%) were conservatively treated. In-hospital complications, including the use of inotropes or intra-aortic balloon counterpulsation and the need for mechanical ventilation, did not differ significantly between the groups. The only parameter that showed a trend toward significance was the incidence of heart failure during hospitalization (p=0.042). The risk for 30-day mortality was substantially higher in the conservative treatment group than in the invasive treatment group (27% vs. 10%; p = 0.02). Conclusion: Our data suggested that despite concerns regarding the safety of the primary PCI strategy in the older adult STEMI population, this treatment strategy was associated with a survival benefit.

참고문헌 (Reference)

1 Toleva O, "Treatment choices in elderly patients with ST : elevation myocardial infarction-insights from the vital heart response registry" 2 : e000235-, 2015

2 Thygesen K, "Third universal definition of myocardial infarction" 60 : 1581-1598, 2012

3 Malkin CJ, "The impact of increased age on outcome from a strategy of early invasive management and revascularisation in patients with acute coronary syndromes : retrospective analysis study from the ACACIA registry" 2 : e000540-, 2012

4 Peiyuan H, "The comparison of the outcomes between primary PCI, fibrinolysis, and no reperfusion in patients ≥ 75 years old with ST-segment elevation myocardial infarction: results from the Chinese Acute Myocardial Infarction (CAMI) registry" 11 : e0165672-, 2016

5 Pang J, "The clinical, angiographic and prognosis characteristics of elderly patients with acute ST-segment elevation myocardial infarction : the first elderly STEMI population study in northwest of China" 179 : 326-328, 2015

6 Gupta T, "STEMI care in the elderly : does under-treatment reflect appropriate clinical judgment or therapeutic nihilism?" 68 : 753-755, 2016

7 Jokhadar M, "Review of the treatment of acute coronary syndrome in elderly patients" 4 : 435-444, 2009

8 Van de Werf F, "Reperfusion treatment in acute myocardial infarction in elderly patients" 76 : 830-837, 2018

9 Alexander KP, "Putting the acute coronary syndrome in context after 80 years of age" 135 : 5-6, 2017

10 Dou Q, "Prognostic value of frailty in elderly patients with acute coronary syndrome : a systematic review and meta-analysis" 19 : 222-, 2019

11 Alkhushail A, "Prognosis of primary percutaneous coronary intervention in elderly patients with ST-elevation myocardial infarction" 27 : 85-90, 2015

12 Daud MY, "Procedural outcomes of primary percutaneous coronary intervention in elderly patients with Stemi" 30 : 585-588, 2018

13 Ricci B, "Primary percutaneous coronary intervention in octogenarians" 222 : 1129-1135, 2016

14 Meah MM, "Primary percutaneous coronary intervention in nonagenarians : is it worthwhile?" 21 : 30-, 2021

15 Sakai K, "Primary percutaneous coronary intervention for acute myocardial infarction in the elderly aged ≥75 years" 79 : 50-56, 2012

16 Cepas-Guillen PL, "Outcomes of nonagenarians with ST elevation myocardial infarction" 125 : 11-18, 2020

17 Yudi MB, "Management of patients aged ≥85 years with ST-Elevation myocardial infarction" 118 : 44-48, 2016

18 Montilla Padilla I, "Management of acute coronary syndromes in geriatric patients" 26 : 107-113, 2017

19 Sanchis J, "Invasive versus conservative strategy in frail patients with NSTEMI: the MOSCA-FRAIL clinical trial study design" 72 : 154-159, 2019

20 Lisiak M, "Frailty and quality of life in elderly patients with acute coronary syndrome" 11 : 553-562, 2016

21 Patel A, "Frailty and outcomes after myocardial infarction : insights from the CONCORDANCE registry" 7 : e009859-, 2018

22 Graham MM, "Frailty and outcome in elderly patients with acute coronary syndrome" 29 : 1610-1615, 2013

23 Jee-Hyun Noh ; Hee-Won Jung ; Hyuk Ga ; Jae Young Lim, "Ethical Guidelines for Publishing in the Annals of Geriatric Medicine and Research" 대한노인병학회 26 (26): 1-3, 2022

24 Lattuca B, "Elderly patients with ST-segment elevation myocardial infarction : a patient-centered approach" 36 : 531-539, 2019

25 Cai JX, "Elderly Asian patients have lower revascularisation rates and poorer outcomes for ST-elevation myocardial infarction compared to younger patients" 49 : 3-14, 2020

26 McNeil JJ, "Effect of aspirin on cardiovascular events and bleeding in the healthy elderly" 379 : 1509-1518, 2018

27 Zahler D, "Correction to : relation of lowering door-to-balloon time and mortality in ST segment elevation myocardial infarction patients undergoing percutaneous coronary intervention" 109 : 408-, 2020

28 Caixeta A, "Contrast-induced nephropathy in a high-risk patient population" 3 : 10-15, 2008

29 Pek PP, "Comparison of epidemiology, treatments and outcomes of ST segment elevation myocardial infarction between young and elderly patients" 35 : 289-296, 2018

30 Lattuca B, "Bleeding in the elderly: risk factors and impact on clinical outcomes after an acute coronary syndrome, a sub-study of the randomized ANTARCTIC trial" 21 : 681-691, 2021

31 Chhatriwalla AK, "Association between bleeding events and in-hospital mortality after percutaneous coronary intervention" 309 : 1022-1029, 2013

32 Saraswat A, "An invasive vs a conservative approach in elderly patients with non-ST-segment elevation myocardial infarction : systematic review and meta-analysis" 34 : 274-280, 2018

33 Dziewierz A, "Age-related differences in treatment strategies and clinical outcomes in unselected cohort of patients with ST-segment elevation myocardial infarction transferred for primary angioplasty" 34 : 214-221, 2012

34 Alexander KP, "Acute coronary care in the elderly, Part II. ST-segment-elevation myocardial infarction: a scientific statement for healthcare professionals from the American Heart Association Council on Clinical Cardiology: in collaboration with the Society of Geriatric Cardiology" 115 : 2570-2589, 2007

35 Sui YG, "A retrospective study of an invasive versus conservative strategy in patients aged ≥80 years with acute ST-segment elevation myocardial infarction" 47 : 4431-4441, 2019

36 Ibanez B, "2017 ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the task force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC)" 39 : 119-177, 2018