PPCI less effective in the elderly

In the Apex-AMI (Assessment of Pexelizumab in Acute Myocardial Infarction) trial, the novel anti-inflammatory agent Pexelizumab was not found to improve outcomes when given during PPCI.  However, the study did enrol the largest group of patients 75 years or older with ST-segment elevation myocardial infarction to be treated with primary percutaneous coronary intervention (PPCI) in a clinical trial.  As outcome data for elderly patients undergoing PPCI are limited, the authors performed a post-hoc analysis on this subgroup.

Patients were split into three groups: those younger than 65 (n=3410), those 65 to 74 years old (n=1358), and those aged 75 years or older (n=977).  The main outcome measure was 90-day mortality, and a composite of congestive heart failure, shock, or death at 90 days.

Older patients were noted to have higher rates of comorbidities (such as hypertension and chronic obstructive pulmonary disease), but in addition less procedural success and higher rates of complications.  In the three pre-determined age groups, ninety-day mortality rates were 2.3%, 4.8%, and 13.1%.  In addition, composite outcome rates were 5.9%, 11.9%, and 22.8% for patients younger than 65 years, 65 to 74 years old, and 75 years or older, respectively. Following multivariable adjustment, age was found to be the strongest independent predictor of 90-day mortality (hazard ratio, 2.07 per 10-year increase; 95% confidence interval, 1.84-2.33).

Conclusions:

Older patients undergoing PPCI have lower rates of procedural success, and are more likely to suffer from post-procedural complications.  Age is the strongest predictor of mortality at 90 days in patients undergoing PPCI.

  • Gharacholou SM, Lopes RD, Alexander KP et al. Age and Outcomes in ST-Segment Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention.  Arch Intern Med 2011;171:559-567.