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Original research
Benefit of primary percutaneous coronary interventions in the elderly with ST segment elevation myocardial infarction
  1. Daniel Fernández-Bergés1,2,
  2. Irene R Degano3,
  3. Reyes Gonzalez Fernandez4,
  4. Isaac Subirana3,5,
  5. Joan Vila3,5,
  6. Manuel Jiménez-Navarro6,
  7. Silvia Perez-Fernandez7,8,
  8. Mercé Roqué9,
  9. Antoni Bayes-Genis10,
  10. Francisco Fernandez-Aviles11,
  11. Antonio Mayorga12,
  12. Vicente Bertomeu-Gonzalez13,
  13. Juan Sanchis14,
  14. Marcos Rodríguez Esteban15,
  15. Antonio Sanchez-Hidalgo16,
  16. Esther Sanchez-Insa17,
  17. Ane Elorriaga18,
  18. Emad Abu Assi19,
  19. Alberto Nuñez20,
  20. Jose Manuel Garcia Ruiz21,
  21. Pedro Morrondo Valdeolmillos22,
  22. Daniel Bosch-Portell23,
  23. Iñaki Lekuona24,
  24. Andres Carrillo-Lopez25,
  25. Alberto Zamora26,
  26. Berta Vega-Hernandez27,
  27. Javier Alameda Serrano28,
  28. Catalina Rubert29,
  29. Luis Ruiz-Valdepeñas30,
  30. Laura Quintas31,
  31. Luis Rodríguez-Padial32,
  32. Jessica Vaquero33,
  33. Luis Martinez Dolz34,
  34. Jose A Barrabes35,
  35. Pedro L Sanchez36,
  36. Alessandro Sionis37,
  37. Julio Martí-Almor38,
  38. Roberto Elosua3,7,39,
  39. Rosa-María Lidon40,
  40. David Garcia-Dorado40 and
  41. Jaume Marrugat3,7
  42. on behalf of the ATHOS investigators
  1. 1Unidad de Investigación, Hospital Don Benito-Villanueva, Don Benito, Spain
  2. 2Instituto Universitario de Investigación Biosanitaria de Extremadura, Badajoz, Spain
  3. 3Institut Hospital del Mar d' Investigacions Mediques, Barcelona, Spain
  4. 4Department of Cardiology, Infanta Cristina University Hospital, Badajoz, Spain
  5. 5CIBERESP de Epidemiologia y Salud Publica, Barcelona, Spain
  6. 6Cardiology Department, Virgen de la Victoria University Hospital, Málaga, Spain
  7. 7CIBER Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain
  8. 8Institut Hospital del Mar d'Investigacions Mediques, Barcelona, Spain
  9. 9Hospital Clinic, Barcelona, Spain
  10. 10Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
  11. 11Servicio de Cardiologia, University Hospital Gregorio Marañon, Madrid, Spain
  12. 12Department of Cardiology, Hospital Universitario Gregorio Marañón, Madrid, Madrid, Spain
  13. 13Department of Cardiology, Hospital Universitario de San Juan, Alicante, Spain
  14. 14Cardiology Department, Hospital Clinico Universitario, INCLIVA, Universitat de València, Valencia, Spain
  15. 15Department of Cardiology, Hospital Universitario Nuestra Senora de la Candelaria, Santa Cruz de Tenerife, Spain
  16. 16Consorci Sanitari de Terrassa, Terrassa, Spain
  17. 17Department of Cardiology, Hospital Universitario Miguel Servet, Zaragoza, Spain
  18. 18Department of Cardiology, Hospital Universitario de Basurto, Bilbao, Bilbao, Spain
  19. 19Department of Cardiology, Hospital Álvaro Junqueiro de Vigo, Pontevedra, Vigo, Spain
  20. 20Department of Cardiology, Hospital Universitario Fundación de Alcorcón, Madrid, Spain
  21. 21Hospital Universitario Central de Asturias, Oviedo, Spain
  22. 22Medicina Intensiva, Hospital Universitario Donostia, San Sebastián, San Sebastian, Spain
  23. 23Department of Cardiology, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain
  24. 24Department of Cardiology, Hospital Galdakao-Usansolo, Galdacano, Spain
  25. 25Hospital Universitari Son Espases, Palma de Mallorca, Spain
  26. 26Hospital Comarcal de Blanes, Blanes, Spain
  27. 27Hospital Universitario de Cabueñes, Gijon, Spain
  28. 28Cardiología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
  29. 29Hospital Son Llàtzer, Palma de Mallorca, Spain
  30. 30Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
  31. 31Hospital de Mendaro, Mendaro, Spain
  32. 32Complejo Hospitalario de Toledo, Toledo, Spain
  33. 33Hospital Universitario Araba sede Txagorritxu, Vitoria-Gasteiz, Spain
  34. 34Hospital Universitario La Fe, Valencia, Spain
  35. 35Department of Cardiology, University Hospital Vall d'Hebron, Barcelona, Spain
  36. 36Department of Cardiology, Hospital Universitario Salamanca, Salamanca, Spain
  37. 37Intensive Cardiac Care Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute IIB-Sant Pau, Universitat de Barcelona, Barcelona, Spain
  38. 38Department of Medicine, Department of Cardiology, Hospital del Mar. Universitat Autónoma de Barcelona, Barcelona, Spain
  39. 39Universitat de Vic, Barcelona, Spain
  40. 40Hospital Universitari Vall d' Hebron, Barcelona, Spain
  1. Correspondence to Dr Daniel Fernández-Bergés; polonibo{at}gmail.com

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.

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