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Meta-Analysis
. 2025 Apr 15;14(8):e040435.
doi: 10.1161/JAHA.124.040435. Epub 2025 Apr 10.

Invasive Strategy With Intended Percutaneous Coronary Intervention Versus Conservative Treatment in Older People With ST-Segment-Elevation Myocardial Infarction: A Meta-Analysis

Sascha Macherey-Meyer  1 , David Dilley  2 , Sebastian Heyne  1 , Max Maria Meertens  1   3 , Richard Julius Nies  1 , Samuel Lee  1 , Christoph Adler  1   4 , Stephan Baldus  1 , Ingo Eitel  5 , Thomas Stiermaier  5 , Christian Frerker  5 , Tobias Schmidt  5   6
Affiliations
Meta-Analysis

Invasive Strategy With Intended Percutaneous Coronary Intervention Versus Conservative Treatment in Older People With ST-Segment-Elevation Myocardial Infarction: A Meta-Analysis

Sascha Macherey-Meyer et al. J Am Heart Assoc. .

Abstract

Background: Patients ≥80 years old were underrepresented or excluded from landmark trials demonstrating the superiority of primary percutaneous coronary intervention (PCI) in ST-segment-elevation myocardial infarction. The current meta-analysis assessed the effects of an invasive strategy with intended PCI compared with conservative treatment in older people (≥80 years) with ST-segment-elevation myocardial infarction.

Methods: A structured literature search was performed. The primary outcome was overall survival. Secondary outcome analyses included but were not limited to 30-day and 1-year mortality.

Results: Thirteen studies reporting on 102 158 older adults were included. Of these, 31 629 (31%) were assigned to PCI and 70 529 (69%) were treated conservatively. The overall survival was 76.5% in PCI and 67.2% in conservative treatment at the time of longest available follow-up (odds ratio [OR], 2.18 [95% CI, 1.79-2.66], P<0.001, I2=88%, favoring PCI). The follow-up period ranged from 30 days to 26.5 months. The 30-day. (OR, 0.39 [95% CI, 0.31-0.50], P<0.001, I2=0%) and 1-year mortality (OR, 0·34 [95% CI, 0.25-0.46], P<0.001, I2=0%), were lower in the PCI group.

Conclusions: This meta-analysis indicates a potential underuse of PCI in older adults with ST-segment-elevation myocardial infarction. PCI was advantageous in short- and long-term survival, but these results were affected by confounding. Nonetheless, every second patient not referred for invasive treatment survived at least 1 year. These findings have hypothesis generating implications, but they indicate ageism and emphasize that PCI should not be automatically withheld in older patients.

Keywords: STEMI; centenarians; nonagenarians; octogenarians; optimal medical therapy; percutaneous coronary intervention.

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Conflict of interest statement

Sascha Macherey‐Meyer:received travel costs from Bayer Vital AG; received research grants from Elisabeth & Rudolf Hirsch Foundation; participates as subinvestigator in a clinical trial sponsored by AstraZeneca. Sebastian Heyne: travel grant from Eli Lilly, research grant from Deutsche Herzstiftung e.V. Stephan Baldus: received lecture fees from Abbott, Edwards, AstraZeneca and JenaValve; received research grants from Abbott and AstraZeneca; participates as principal investigator in a clinical trial sponsored by AstraZeneca. The remaining authors have no disclosures to report.

Figures

Figure 1
Figure 1. Flow chart diagram.
STEMI indicates ST‐segment–elevation myocardial infarction.
Figure 2
Figure 2. Forest plot of overall survival analysis.
CON indicates conservative treatment; M‐H, Mantel–Haenszel; and PCI, percutaneous coronary intervention.
Figure 3
Figure 3. Secondary mortality analyses. A, In‐hospital mortality. B, 30‐day mortality. C, 1‐year mortality. D, Cardiac mortality.
CON indicates conservative treatment; M‐H, Mantel–Haenszel; and PCI, percutaneous coronary intervention.
Figure 4
Figure 4. Forest plot of major bleeding.
CON indicates conservative treatment; M‐H, Mantel–Haenszel; and PCI, percutaneous coronary intervention.
See this image and copyright information in PMC

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