Reperfusion strategies on the clinical outcomes of ST-elevation myocardial infarction patients over 80 years old in China

Abstract

Aims: This study aims to explore the efficacy of reperfusion strategies on the clinical outcomes of ST-elevation myocardial infarction (STEMI) patients over 80 years old in China.

Methods and results: A retrospective cohort study was performed on STEMI patients over 80 years old who underwent reperfusion strategies and no reperfusion between January 2014 and December 2021, based on the Chinese Cardiovascular Association (CCA) Database-Chest Pain Center. This study included a total of 42,699 patients (mean age 84.1 ± 3.6 years, 52.2% male), among whom 19,280 (45.2%) underwent no reperfusion, 20,924 (49.0%) underwent primary percutaneous coronary intervention (PCI), and 2495 (5.8%) underwent thrombolytic therapy. After adjusting for potential confounders, multivariable logistic regression analysis revealed that patients who underwent primary PCI strategy showed a significantly lower risk of in-hospital mortality [odds ratio (OR) = 0.62, 95% confidence interval (CI): 0.57-0.67, P < 0.001] and the composite outcome (OR = 0.83, 95% CI: 0.79-0.87, P < 0.001) compared to those who received no reperfusion. In contrast, patients with thrombolytic therapy exhibited a non-significantly higher risk of in-hospital mortality (OR = 0.99, 95% CI: 0.86-1.14, P = 0.890) and a significantly elevated risk of the composite outcome (OR = 1.15, 95% CI: 1.05-1.27, P = 0.004). During a median follow-up of 6.7 months post-hospital admission, there was a percentage 31.4% of patients died, and patients in the primary PCI group consistently demonstrated a reduced incidence of all-cause mortality (hazard ratio (HR) = 0.58, 95% CI: 0.56-0.61, P < 0.001).

Conclusion: STEMI patients over 80 years old who underwent the primary PCI strategy are more likely to have favourable clinical outcomes compared to those who received no reperfusion, whereas thrombolytic therapy warrants careful assessment and monitoring.

Keywords: Mortality; Older; Reperfusion strategy; ST-elevation myocardial infarction.