Invasive vs. Conservative Treatment Approach among Elderly Patients with Acute ST- Segment Elevation Myocardial Infarction

Introduction

Primary percutaneous coronary intervention (PCI) is the preferred treatment strategy in a patient with ST-Elevation myocardial infarction (STEMI); however, in very elderly patients with STEMI, its efficacy remains unclear.

The aim of this study was to compare the utilization of primary PCI as opposed to conservative treatment among elderly patients presenting with STEMI.

Material and methods

We performed a retrospective single-center observational study at the Tel Aviv Sourasky Medical Center. We included 530 patients > 75 years admitted with the diagnosis of an acute STEMI. Primary PCI was performed in patients with symptoms ≤12 hours in duration as well as in patients with symptoms lasting 12-24 hours if pain consisted at the time of admission, while the other patients were treated conservatively. Patient records were evaluated for 30-day mortality and complications occurring throughout hospitalization.

Results

Of the study patients group, only 28/530 (5%) patients were treated conservatively. We found that there was no difference in in-hospital complications between the groups including- cardiogenic shock or the need for intra-aortic balloon counterpulsation (IABC) treatment, mechanical ventilation, clinically significant tachyarrhythmias, bradyarrhythmias requiring pacemaker and major bleedings (requiring blood transfusion). The only parameter which had a trend toward significance was the incidence of heart failure during hospitalization ( p=0.07).

30-days mortality was 10% and 14% in the invasive and conservative treatment groups respectively (p=0.5). 1-year mortality was 13% in the invasive treatment group and 18% in the conservative treatment group ( p=0.4).

Conclusion

Although PCI is considered to be the preferred treatment for patients admitted with STEMI, its seems that each case should be considered on its own merits for the very elderly patients.