PCI Beneficial for All Categories of Older AMI Patients

PCI linked to improved survival versus medical therapy for young-old, middle-old, and old-old patients
plaque in artery
plaque in artery

WEDNESDAY, April 24, 2019 (HealthDay News) -- For older patients with acute myocardial infarction (AMI), percutaneous coronary intervention (PCI) is beneficial across age strata, according to a research letter published online April 23 in Circulation: Cardiovascular Interventions.

Abdulla A. Damluji, M.D., M.P.H., from the Sinai Hospital of Baltimore, and colleagues examined use of revascularization among 469,827 patients categorized according to age at first AMI as young-old (75 to 79 years; 34 percent), middle-old (80 to 84 years; 30 percent), and old-old (85 to 89 years; 36 percent).

The researchers found that PCI was performed in 38, 33, and 20 percent of young-old, middle-old, and old-old groups, respectively. From 2000 to 2016, the rate of PCI utilization increased in the young-old and middle-old groups and was paralleled by a decrease in unadjusted mortality rates in later years (mortality rate in 2016: 5 and 7 percent for young-old and middle-old, respectively). The rate of PCI utilization increased from 10 to 25 percent for old-old patients with AMI, while the unadjusted mortality rate decreased from 17 to 11 percent. PCI was associated with improved survival in all three categories compared with medical therapy (unadjusted odds ratios, 0.47, 0.51, and 0.58 for young-old, middle-old, and old-old, respectively). PCI use remained associated with a survival benefit in all age strata in multivariable analysis.

"The results remain valuable to inform physicians treating older patients with AMI, as this group of patients is usually underrepresented in most clinical trials," the authors write.

One author disclosed financial ties to the publishing and pharmaceutical industries.

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