Clinical practice and outcomes in elderly STEMI patients undergoing PCI with new generation DES – data from a large worldwide registry
Abstract Background The best treatment option for elderly patients with acute myocardial infarction (MI) remains unclear. Purpose We aimed to determine clinical practice and outcomes of PCI with a new generation DES in patients with ST-elevated MI (STEMI), aged ≥80 years included in a one of the lar...
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Published in | European heart journal Vol. 41; no. Supplement_2 |
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Main Author | |
Format | Journal Article |
Language | English |
Published |
01.11.2020
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Online Access | Get full text |
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Summary: | Abstract
Background
The best treatment option for elderly patients with acute myocardial infarction (MI) remains unclear.
Purpose
We aimed to determine clinical practice and outcomes of PCI with a new generation DES in patients with ST-elevated MI (STEMI), aged ≥80 years included in a one of the largest real-world PCI registries.
Methods
e-Ultimaster is a prospective, world-wide, multi-centre registry that enrolled 36,671 patients with coronary artery disease, treated with a thin strut sirolimus-eluting stent with abluminal bioresorbable polymer coating, across 50 countries. 34,538 patients who completed 1-year follow-up or who died were included in the analysis. The primary endpoint was 1-year target lesion failure (TLF: cardiac death, target vessel (TV) MI, clinically driven (CD) target lesion revascularization (TLR)). An Clinical Event Committee adjudicated all endpoint-related adverse events.
Results
6863 presented with STEMI at baseline (19.9%). Mean age of STEMI patients was 61.0±11.7 years, with 78.8% males. Diabetes was present in 20.9% and hypertension in 52.4%.
Of 6863 STEMI patients, 430 patients (6.2%) were aged ≥80 years, with 46.5% females compared to 19.5% females in the younger group. Patients in the older group had more comorbidities (hypertension and renal impairment) and more often took oral anticoagulant medication (9.2% vs 3.9%; p<0.001). At discharge 94.9% of older STEMI patients were on dual antiplatelet therapy (DAPT) as compared to 97.6% of younger STEMI patients (p=0.002). Older STEMI patients more often took clopidogrel as second antiplatelet agent (54.7% vs 39.8%; p<0.001) and were less often on prasurgrel (2.3%vs 10.9%; p<0.001) and ticagrelor (41.2% vs 48.1%; p=0.005).
STEMI patients in the older group more often had multivessel disease (52.1 vs 45.8%; p=0.01), treatment of the left main artery (4.7 vs 1.4%; p<0.001) and more calcified lesions (18.8 vs 11.2%; p<0.001). Other lesion characteristics were similar between the two groups. Preferred access approach was radial and was alike in the two groups (87.0 vs 84.0%; p=0.10)
In-hospital mortality was more frequent in older STEMI patients (2.3% vs 0.8%; p=0.003). More bleedings were observed in older vs younger STEMI patients at discharge.
One-year TLF was significantly higher in older age group (7.0% vs 3.0%; p<0.01), mainly driven by increased rates of cardiac death. All-cause mortality and bleedings were also more frequent in older STEMI patients. No differences were observed in revascularization or ST rates (1.4 vs 1.1%; p=0.48).
Conclusions
In elderly patients with STEMI, in-hospital mortality rates as well as bleeding rates were higher as compared to younger patients, while 1-year rates of revascularization and ST did not differ between the groups.
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Terumo Europe |
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ISSN: | 0195-668X 1522-9645 |
DOI: | 10.1093/ehjci/ehaa946.1777 |