Abstract 12552: Is Primary Angioplasty the Best Reperfusion Strategy in Very Old Patients With Myocardial Infarction? A Systematic Overview of Randomized Control Trials
Background: Overall, primary percutaneous coronary intervention (PCI) is the preferred therapy in STEMI. However, in older patients -the fastest growing population group- individual randomized control trials (RCT's) have failed to demonstrate superiority of PCI over fibrinolysis (lysis) due to the small number of patients enrolled in each of these RCT's.
Objective: We compared PCI and lysis in old patients presenting with STEMI by pooling data from RCT's. The primary end point of the analysis was a composite of death, reinfarction and disabling stroke at 30 days.
Methods: Data from three reperfusion trials performed specifically in older patients (De Boer, SENIOR:PAMI, and TRIANA) were analyzed. The overview included 834 patients, 430 allocated to PCI and 404 lysis. Individual and overall OR and 95% CI were calculated, with studies weighted according to the Mantel-Haenszel method. Heterogeneity was assessed by using a fixed effects model.
Results: Mean age of the study population was 81 years, and 57% of patients were men. The two treatment groups were well balanced with regard to baseline clinical variables. Door-to- needle time averaged 56 min, and door-to-balloon 86 min. As shown in the figure, the primary end-point was reached by 64 patients in the PCI arm (14.9%), and 87(21%) in the lysis arm(p=0.013):
Conclusions: As in the remaining age groups, primary PCI constitutes the best reperfusion therapy in older patients presenting with STEMI.
- © 2010 by American Heart Association, Inc.