Article Text
Abstract
Objective Primary percutaneous coronary intervention (P-PCI) has demonstrated its efficacy in patients with ST segment elevation myocardial infarction (STEMI). However, patients with STEMI ≥75 years receive less P-PCI than younger patients despite their higher in-hospital morbimortality. The objective of this analysis was to determine the effectiveness of P-PCI in patients with STEMI ≥75 years.
Methods We included 979 patients with STEMI ≥75 years, from the ATención HOspitalaria del Síndrome coronario study, a registry of 8142 consecutive patients with acute coronary syndrome admitted at 31 Spanish hospitals in 2014–2016. We calculated a propensity score (PS) for the indication of P-PCI. Patients that received or not P-PCI were matched by PS. Using logistic regression, we compared the effectiveness of performing P-PCI versus non-performance for the composite primary event, which included death, reinfarction, acute pulmonary oedema or cardiogenic shock during hospitalisation.
Results Of the included patients, 81.5 % received P-PCI. The matching provided two groups of 169 patients with and without P-PCI. Compared with its non-performance, P-PCI presented a composite event OR adjusted by PS of 0.55 (95% CI 0.34 to 0.89).
Conclusions Receiving a P-PCI was significantly associated with a reduced risk of major intrahospital complications in patients with STEMI aged 75 years or older.
- coronary intervention (PCI)
- stemi
- acute coronary syndrome
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Contributors DF-B: contributed to acquisiton, analysis and interpretation of the data for the work; drafted the manuscript; gave final approval; and agrees to be accountable for all aspects of work in ensuring integrity and accuracy. IRD: contributed to conception and interpretation of the data for the work; critically revised the manuscript; gave final approval; and agrees to be accountable for all aspects of work in ensuring integrity and accuracy. MR: contributed to interpretation of the data for the work; drafted the manuscript; gave final approval; and agrees to be accountable for all aspects of work in ensuring integrity and accuracy. IS: contributed to design, analysis and interpretation of the data for the work; drafted the manuscript; gave final approval; and agrees to be accountable for all aspects of work in ensuring integrity and accuracy. JV: contributed to conception; critically revised the manuscript; gave final approval; and agrees to be accountable for all aspects of work in ensuring integrity and accuracy. SP-F: contributed to analysis of the data for the work; critically revised the manuscript; gave final approval; and agrees to be accountable for all aspects of work in ensuring integrity and accuracy. MJ-N, MR, AB-G, AM, VBG, JS, MR, AS-H, ES-I, AE, EAA, AN, PMV, DB-P, IL, AC-L, AZ, BV-H, JAS, CR, LR-V, LQ, LR-P, JV, LMD, PLS, AS, JM-A and R-ML: contributed to acquisiton of the data for the work; drafted the manuscript; gave final approval; and agrees to be accountable for all aspects of work in ensuring integrity and accuracy. FF-A, RE and DG-D: contributed to conception and design of the work; critically revised the manuscript; gave final approval; and agrees to be accountable for all aspects of work in ensuring integrity and accuracy. JMGR: contributed to acquisiton of the data for the work; drafted the manuscipt; gave final approval; and agrees to be accountable for all aspects of work in ensuring integrity and accuracy. JAB: contributed to acquisiton of the data for the work; gave final approval; and agrees to be accountable for all aspects of work in ensuring integrity and accuracy. JM: contributed to conception and design of the work, analysis, interpretation of the data for the work; critically revised the manuscript; gave final approval; and agrees to be accountable for all aspects of work in ensuring integrity and accuracy.
Funding Supported by: MARATO TV3 (081630), de AGAUR (2014SGR240); del Instituto de Salud Carlos III: Red de Investigación Cardiovascular RD12/0042 (Programa HERACLES); Red RedIAPP RD06/0018; CP12/03287; CIBER Epidemiología y Salud Pública; CIBERCV de enfermedades Cardiovasculares, Fondo Europeo de Desarrollo Regional (FEDER) (European Regional Development Funds -ERDF-); FIS CP12/03287, FIS 14/00449, FIS PI081327, FIS INTRASALUD PI1101801.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval The study was approved by the clinical research ethics committee of IMIM-Hospital del Mar (reference 2014/5491/1), and was declared by the Medicines and Healthcare Products Regulatory Agency to be a study in which the medicine is not the fundamental exposure factor investigated (registration: 2258/RG 4274).
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement No data are available. ATHOS is a collaborative observational study with participation of more than 30 hospitals. To share the complete database all Hospital PIs would have to acknowledge the data sharing, which is not impossible but quite difficult under normal conditions. For exceptionally important projects all PI’s acceptance could be sought.