Study Reveals Positive Impact of Primary PCI on Elderly Chinese Patients with Heart Attacks
In a recent study conducted in China,
researchers explored the prevalence and outcomes of primary percutaneous
coronary intervention (PCI) in individuals aged 75 years and older who
experienced ST-segment elevation myocardial infarction (STEMI). The research,
based on data collected from a multicenter registry between 2013 and 2014,
provides insights into the underutilization of primary PCI in Chinese clinical
practice and emphasizes its significant potential to improve outcomes in
elderly STEMI patients. The study found that Patients who received primary PCI exhibited a noteworthy
reduction in the risk of two-year all-cause mortality, major adverse cardiac
and cerebrovascular events (MACCE), and cardiac death compared to those
who did not undergo reperfusion.
The
observational study was published in the International
Journal of Cardiology Cardiovascular Risk and Prevention.
Older Patients
aged ≥75, face high mortality due to age-related comorbidities due to with ST-segment elevation
myocardial infarction (STEMI). Hence, researchers using the China Acute Myocardial
Infarction Registry aimed to assess primary PCI prevalence and outcomes in
these older patients. Despite guidelines supporting invasive management, the
real-world scenario shows declining primary PCI rates with age, raising
concerns about disparities between developed and developing countries like
China. The
research addresses the gap by examining whether primary PCI improves outcomes
in older Chinese STEMI patients, including those aged ≥85.
The primary
outcome measured was all-cause mortality, and the secondary outcome was major
adverse cardiac and cerebrovascular events (MACCE), which included a composite
of all-cause mortality, cardiac death, recurrent myocardial infarction (MI),
stroke, revascularization, and major bleeding.
Findings:
- Examining a cohort of 999 STEMI
patients aged 75 and above, the study found that around 32.9% of these
individuals underwent primary PCI. - Patients who received primary PCI
showed a significant reduction in the risk of two-year all-cause mortality,
MACCE, and cardiac death compared to those who did not undergo reperfusion. - Notably, the two-year all-cause
mortality rate dropped from 36.4% without reperfusion to 18.0% with primary
PCI. - Similar trends were observed in MACCE
(43.5% without reperfusion vs. 28.7% with primary PCI) and cardiac death (23.6%
without reperfusion vs. 10.0% with primary PCI). - Importantly, the study also delved
into age-specific nuances, revealing that the positive outcomes associated with
primary PCI extended to STEMI patients aged 85 years and older. - This
underscores the potential benefits of the intervention even in the very elderly
population. - Subgroup analysis further supported
the efficacy of primary PCI, demonstrating its superiority in patients with
high-risk profiles, such as those experiencing cardiogenic shock or facing
delayed hospital admission.
Notably, no significant differences
were observed in recurrent myocardial infarction, stroke, revascularization,
and major bleeding between the primary PCI and no reperfusion groups.
However, despite these promising
results, the study highlighted a concerning trend of underutilization of
primary PCI in Chinese clinical practice. Even with its proven benefits in
reducing mortality and improving cardiac outcomes, a significant portion of
eligible patients did not receive this potentially life-saving intervention.
In conclusion, this comprehensive
study underscores the pivotal role of primary PCI in enhancing outcomes for
elderly Chinese patients grappling with STEMI. The findings advocate for a
paradigm shift in clinical practices, urging healthcare professionals to
embrace and implement primary PCI more widely to ensure that elderly
individuals receive the optimal care necessary to mitigate the devastating
impact of heart attacks.
Further reading: The prevalence and
outcomes in STEMI patients aged ≥75 undergoing primary percutaneous coronary
intervention in China. Doi: https://doi.org/10.1016/j.ijcrp.2024.200251
