Abstract 17061: Primary Pci Strategy for Non-st Elevation Acute Coronary Syndrome in Elderly Patients (>75y/o): An Analysis of the Aboard Study
Aim: The multicenter randomized ABOARD Study demonstrated that in Non ST-Elevation Acute Coronary Syndrome (NSTEACS) patients, a primary PCI strategy is feasible and associated with a shorter hospital stay. Whether this strategy remains safe and effective in elderly patients is unknown.
Methods: We performed an analysis of the ABOARD study and compared the efficacy and safety of the primary PCI strategy in elderly patients (>75y/o) and younger patients (≤75y/o). The primary endpoint was myocardial infarction (MI) using the new definition based on troponin release (primary endpoint of the main study) and the key secondary end point was the composite of death, MI, or urgent revascularization at 1 month.
Results: Of the 352 patients randomized in the ABOARD study, 92 were >75 yrs (26.1%). Mean age was 80±4 yrs, with more women (43.5% vs. 23.1%), more frequent hypertension (73.9% v.59.6%) and lower body weight (70.7±13.5 vs.78.5±15kg) in the elderly compared with younger patients (p for all <0.01). TIMI risk score was ≥ 5 in 40.2% of elderly patients with 71.7% of positive troponin on admission. Patients were all treated with aspirin and clopidogrel (665±274mg LD and 140±66mg MD). Abciximab was used in 97% of PCI patients. Radial access was use in 83.7% of elderly patients and revascularization was performed in 81.8% of them with a lower rate of CABG (8.4% vs. 12.1% p=0.02) despite more frequent left main disease (11.9% vs. 7.0%, p=0.02) than younger patients Primary PCI strategy was not superior to next day PCI in the elderly with a median troponin release of 2.46 (IQR 0.3–9.8) vs. 3.04 (IQR 0.9–8.7), p=0.5 just like in younger patients 1.99 (IQR 0.3–6.5) vs. 1.12 (IQR 0.2–7.2), p=0.4. The key secondary endpoint was similar for the two strategies in the elderly (4.2% vs. 4.5% p=1.0) as in younger patients (2.4% vs. 0% p=0.12). Mortality at one month and major bleeding complications were also similar between the two strategies but were both higher in the elderly than in younger patients, respectively (4.3% vs. 1.2% p=0.01) and (9.9% vs. 3.8% p=0.01).
Conclusions: A primary PCI type strategy is feasible but it is not clinically superior to intervention scheduled within 24 hours of admission in elderly NSTE-ACS patients who bear a high mortality and bleeding complication risk.
- © 2010 by American Heart Association, Inc.