Danish Registry Supports Primary PCI in Elderly STEMI Patients

April 30, 2013—Lisbeth Antonsen, MD, et al published data from the Western Denmark Heart Registry analysis of outcomes after primary percutaneous coronary intervention (PCI) in octogenarians and nonagenarians with ST-segment elevation myocardial infarction (STEMI) in Catheterization and Cardiovascular Interventions (2013;81:912–919).

Because elderly STEMI patients constitute a particular risk group in relation to primary PCI, the study investigators examined the proportion of octogenarians and nonagenarians undergoing primary PCI in Western Denmark and their short- and long-term mortality rates. From 2002 to 2009, all consecutive patients ≥ 80 years with STEMI treated with primary PCI were identified in the population-based Western Denmark Heart Registry. Cox regression analysis was used to compute hazard ratios, controlling for potential confounding.

As summarized in Catheterization and Cardiovascular Interventions, a total of 1,322 elderly patients (1,213 octogenarians and 109 nonagenarians), corresponding to 11.6% of the total primary-PCI–treated STEMI population, was treated with primary PCI between 2002 and 2009. The annual proportion of octogenarians referred for primary PCI increased from n = 52 (6.2%) in 2002 to n = 172 (11.8%) in 2009 (P < .01). For nonagenarians, the proportion remained unchanged: n = 6 (0.6%) in 2002 and n = 13 (0.8%) in 2009 (P = NS).

For octogenarians and nonagenarians, the 30-day mortality rate was 17.2% versus 25.8% (log-rank P = .028); 1-year mortality was 27.6% versus 32.5% (log-rank P = .18); and 5-year mortality, 53.6% versus 57.3% (log-rank P = .087), respectively. Adjusted 30-day hazard ratio (HR) = 1.59 (95% confidence interval [CI], 1.07–2.36); 1-year HR = 1.34 (CI, 0.95–1.90); and 5-year mortality HR = 1.39 (CI, 1.04–1.85) were higher in nonagenarians compared with octogenarians.

The investigators found that the annual proportion of octogenarians with STEMI treated with primary PCI doubled from 2002 to 2009, while the proportion of nonagenarians remained unchanged. They concluded that although nonagenarians had the highest short- and long-term mortality, the outcomes were acceptable, with a 5-year survival rate of more than 40% in both groups.