TORNA ALL’ELENCO

Primary percutaneous coronary intervention in nonagenarian patients in European Heart Journal

2020
AOU Città della Salute di Torino

Tipo pubblicazione

Conference Abstract

Autori/Collaboratori (11)Vedi tutti...

Angelini F

Fortuni F

Bellettini M


et alii...

Abstract

Background: Given the continuous increase in life expectancy, elderly patients with ST segment elevation myocardial infarction (STEMI) are becoming a growing proportion of those referred for primary percutaneous coronary intervention (pPCI). However, this population is usually excluded from randomized trials and limited data are available to guide clinical decisions. The aim of this study-level meta-analysis was to describe and analyze the determinants of outcomes in this population. Methods: We searched the literature for studies reporting ischemic and hemorrhagic outcomes and/or mortality in nonagenarian patients undergoing pPCI. An analysis of the heterogeneity between studies in outcome reports was performed with I2 test. A univariate meta-regression analysis was conducted to explore the relationship between outcomes of interest and classic cardiovascular risk factors, gender, previous myocardial infarction (MI), MI location, PCI characteristics, hemodynamic instability, vascular access, intra-aortic balloon pump (IABP) and Glycoprotein IIb/IIIa inhibitor (GPI) use. Results: Overall, 15 observational studies met our inclusion criteria, with a total of 6787 patients; mean age was 92.4 and 35% were male. The incidence of in-hospital death was 21.3%, 1.4% of our population suffered an in-hospital ischemic stroke and 11.1% faced acute renal failure; in-hospital major bleedings affected 1.7% of the population, but bloodtransfusion was needed in 6.9%. Long-term mortality rate was 21.5%. Killip III-IV at admission was related with increased in-hospital mortality (?: 0.2%; p: 0.041), but lower incidence of ARF (?: -0.6%; p: 0.004). Angiographic success was associated with a lower incidence of long-term allcause mortality (?: -1.7%; p: 0.017) and higher incidence of ARF (?: 1.7%, p<0.001). A higher number of coronary stents implanted was associated with a lower incidence of long-term all-cause mortality (?: -73%; p: 0.01). A higher long-term all-cause mortali

DOI : 10.1093/ehjci/ehaa946.1744

Keywords

adenosine diphosphate ribosylation factor; endogenous compound; fibrinogen receptor; acute kidney failure; aged; all cause mortality; bleeding; blood transfusion; brain ischemia; cardiovascular risk factor; cohort analysis; conference abstract; controlled study; coronary stent; diabetes mellitus; feasibility study; female; gender; heart infarction; heart muscle reperfusion; hemodynamics; hospital mortality; human; incidence; intraaortic balloon pump; long term survival; male; meta analysis; mortality rate; observational study; percutaneous coronary intervention; systematic review; vascular access; very elderly;