Prognosis of PCI in AMI setting in the elderly population: Outcomes from the multicenter prospective e-ULTIMASTER registry

Abstract

Background: Elderly patients with ST-elevation myocardial infarction (STEMI) who undergo percutaneous coronary intervention (PCI) are usually excluded from major trials.

Hyopthesis: This study sought to assess 1-year clinical outcomes following PCI with a drug-eluting stent in patients older than 80 years old with STEMI.

Methods: The large all-comer, multicontinental e-ULTIMASTER registry included 7507 patients with STEMI who underwent PCI using the Ultimaster stent. The primary clinical endpoint was 1-year target lesion failure, a composite of cardiac death (CD), target vessel-related myocardial infarction (TV-MI), or clinically driven target lesion revascularization (CD-TLR).

Results: There were 457 (6.1%) patients in the elderly group (≥80 years old) that were compared to 7050 (93.9%) patients <80 years. The elderly patients included more female patients and had significantly more comorbidities and had more complex coronary anatomy. The primary endpoint occurred in 7.2% of the elderly, compared to 3.1% of the younger group (p < .001). All-cause mortality was significantly higher among the elderly group compared to the younger group (10.1% vs. 2.3%, p < .0001), as well as CD (6.1% vs. 1.6%, p < .0001), but not TV-MI (1.1% vs. 0.7%, p = .34) or CD-TLR (1.1% vs. 1.4%, p = .63).

Conclusion: Elderly patients with STEMI presentation had a higher incidence of the composite endpoint than younger patients. All-cause and CD were higher for elderly patients compared to patients younger than 80 years old. However, there was no difference in the incidence of TV-MI or target lesion revascularizations. These findings suggest that PCI for STEMI in elderly patients is relatively safe.

Keywords: age; coronary artery disease; elderly; myocardial infarction; outcome; stent.

Figure 1

Unadjusted event rate at 1 year. CD, clinically driven; MI, myocardial infarction; POCE, patient‐oriented composite endpoint; ST, stent thrombosis (definite/probable); TLF, target lesion failure; TLR, target lesion revascularization; TVR, target vessel revascularization; TV‐MI, target vessel myocardial infarction.

Figure 2

Odds ratio (OR) for TLF rate at 1 year after stepwise multivariable analysis. CABG, coronary artery bypass grafting; CI, confidence interval; PCI, percutaneous coronary intervention; STEMI, ST‐elevation myocardial infarction; TLF, target lesion failure.

Figure 3

Kaplan–Meir cumulative incidence of events curves after inverse‐weighted propensity score adjustment. HR, hazard ratio.

Figure A1

Standardized differences in variables included in the propensity score between groups. After adjustment, all covariates in the planned propensity score had weighted standardized differences below 0.1, which indicates an equilibration of these covariates between the groups. CABG, coronary artery bypass grafting; CTO, chronic total occlusion; PTCA, percutaneous transluminal coronary angioplasty.

Figure A2

Patient disposition of patients enrolled in the e‐ULTIMASTER study and grouped according to STEMI‐elderly (≥80 years) and STEMI‐nonelderly (<80 years). STEMI, ST‐elevation myocardial infarction.