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Pharmacoinvasive Strategy Versus Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction in Patients ≥70 Years of Age.
Am J Cardiol 2020; 125(1):1-10AJ

Abstract

The benefit-risk ratio of a pharmacoinvasive strategy (PI) in patients ≥70 years of age with ST-segment elevation myocardial infarction (STEMI) remains uncertain resulting in its limited use in this population. This study compared efficacy and safety of PI with primary percutaneous coronary intervention (pPCI). Data from 2,841 patients (mean age: 78.1 ± 5.6 years, female: 36.1%) included in a prospective multicenter registry, and who underwent either PI (n = 269) or pPCI (n = 2,572), were analyzed. The primary end point was in-hospital major adverse cardiovascular events (MACE) defined as the composite of all-cause mortality, nonfatal MI, stroke, and definite stent thrombosis. Secondary end points included all-cause death, major bleeding, net adverse clinical events, and the development of in-hospital Killip class III or IV heart failure. Propensity-score matching and conditional logistic regression were used to adjust for confounders. Within the matched cohort, rates of MACE was not statistically different between the PI (n = 247) and pPCI (n = 958) groups, (11.3% vs 9.0%, respectively, odds ratio 1.25, 95% confidence interval 0.81 to 1.94; p = 0.31). Secondary end points were comparable between groups at the exception of a lower rate of development of Killip class III or IV heart failure after PI. The rate of intracranial hemorrhage was significantly higher in the PI group (2.3% vs 0.0%, p = 0.03). In conclusion, the present study demonstrated no difference regarding in-hospital MACE following PI or pPCI in STEMI patients ≥70 years of age. An adequately-powered randomized trial is needed to precisely define the role of PI in this high-risk subgroup.

Authors+Show Affiliations

Department of Cardiology and Vascular Diseases, Pontchaillou University Hospital, University of Rennes 1, Rennes, France; Center for Clinical Investigation 804, Signal and Image Treatment laboratory (LTSI), National Institute of Health and Medical Research U1099, Rennes, France. Electronic address: vincent.auffret@chu-rennes.fr.Department of Cardiology and Vascular Diseases, Pontchaillou University Hospital, University of Rennes 1, Rennes, France; Center for Clinical Investigation 804, Signal and Image Treatment laboratory (LTSI), National Institute of Health and Medical Research U1099, Rennes, France; Department of Cardiology, General Hospital of Atlantic Brittany, Vannes, France.Department of Cardiology and Vascular Diseases, Pontchaillou University Hospital, University of Rennes 1, Rennes, France; Center for Clinical Investigation 804, Signal and Image Treatment laboratory (LTSI), National Institute of Health and Medical Research U1099, Rennes, France.Department of Cardiology, La Cavale Blanche University Hospital, Optimization of physiological Regulations, Science and Technical Training and ResearchUnit, Brest, France.Department of Cardiology, General Hospital of Atlantic Brittany, Vannes, France.Department of Cardiology, General Hospital of South Brittany, Lorient, France.Department of Cardiology, General Hospital Yves Le Foll, St-Brieuc, France.Department of Cardiology, General Hospital René Théophile Laennec, Quimper, France.Department of Cardiology, General Hospital Broussais, St-Malo, France.Department of Cardiology, Clinic St-Laurent, Rennes, France.Department of Medical Emergency, General Hospital Yves Le Foll, St-Brieuc, France.Department of Medical Emergency, General Hospital of Atlantic Brittany, Vannes, France.Department of Medical Emergency, Pontchaillou University Hospital, Rennes, France.Department of Medical Emergency, La Cavale Blanche University Hospital, Brest, France.Department of Cardiology and Vascular Diseases, Pontchaillou University Hospital, University of Rennes 1, Rennes, France; Center for Clinical Investigation 804, Signal and Image Treatment laboratory (LTSI), National Institute of Health and Medical Research U1099, Rennes, France.Department of Cardiology and Vascular Diseases, Pontchaillou University Hospital, University of Rennes 1, Rennes, France; Center for Clinical Investigation 804, Signal and Image Treatment laboratory (LTSI), National Institute of Health and Medical Research U1099, Rennes, France.Department of Cardiology and Vascular Diseases, Pontchaillou University Hospital, University of Rennes 1, Rennes, France; Center for Clinical Investigation 804, Signal and Image Treatment laboratory (LTSI), National Institute of Health and Medical Research U1099, Rennes, France.Center for Clinical Investigation 804, Signal and Image Treatment laboratory (LTSI), National Institute of Health and Medical Research U1099, Rennes, France.Department of Cardiology and Vascular Diseases, Pontchaillou University Hospital, University of Rennes 1, Rennes, France; Center for Clinical Investigation 804, Signal and Image Treatment laboratory (LTSI), National Institute of Health and Medical Research U1099, Rennes, France.Department of Cardiology, La Cavale Blanche University Hospital, Optimization of physiological Regulations, Science and Technical Training and ResearchUnit, Brest, France.Department of Cardiology and Vascular Diseases, Pontchaillou University Hospital, University of Rennes 1, Rennes, France; Center for Clinical Investigation 804, Signal and Image Treatment laboratory (LTSI), National Institute of Health and Medical Research U1099, Rennes, France.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31685213

Citation

Auffret, Vincent, et al. "Pharmacoinvasive Strategy Versus Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction in Patients ≥70 Years of Age." The American Journal of Cardiology, vol. 125, no. 1, 2020, pp. 1-10.
Auffret V, Laurin C, Leurent G, et al. Pharmacoinvasive Strategy Versus Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction in Patients ≥70 Years of Age. Am J Cardiol. 2020;125(1):1-10.
Auffret, V., Laurin, C., Leurent, G., Didier, R., Filippi, E., Hacot, J. P., ... Breton, H. L. (2020). Pharmacoinvasive Strategy Versus Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction in Patients ≥70 Years of Age. The American Journal of Cardiology, 125(1), pp. 1-10. doi:10.1016/j.amjcard.2019.09.044.
Auffret V, et al. Pharmacoinvasive Strategy Versus Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction in Patients ≥70 Years of Age. Am J Cardiol. 2020 Jan 1;125(1):1-10. PubMed PMID: 31685213.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pharmacoinvasive Strategy Versus Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction in Patients ≥70 Years of Age. AU - Auffret,Vincent, AU - Laurin,Clément, AU - Leurent,Guillaume, AU - Didier,Romain, AU - Filippi,Emmanuelle, AU - Hacot,Jean-Philippe, AU - Zabalawi,Amer, AU - Rouault,Gilles, AU - Saouli,Djamel, AU - Druelles,Philippe, AU - Coudert,Isabelle, AU - Boulanger,Bertrand, AU - Bot,Emilie, AU - Treuil,Josiane, AU - Bedossa,Marc, AU - Boulmier,Dominique, AU - Loirat,Aurélie, AU - Sharobeem,Sam, AU - Guellec,Marielle Le, AU - Gilard,Martine, AU - Breton,Hervé Le, Y1 - 2019/10/11/ PY - 2019/08/12/received PY - 2019/09/15/revised PY - 2019/09/17/accepted PY - 2019/11/7/pubmed PY - 2019/11/7/medline PY - 2019/11/6/entrez SP - 1 EP - 10 JF - The American journal of cardiology JO - Am. J. Cardiol. VL - 125 IS - 1 N2 - The benefit-risk ratio of a pharmacoinvasive strategy (PI) in patients ≥70 years of age with ST-segment elevation myocardial infarction (STEMI) remains uncertain resulting in its limited use in this population. This study compared efficacy and safety of PI with primary percutaneous coronary intervention (pPCI). Data from 2,841 patients (mean age: 78.1 ± 5.6 years, female: 36.1%) included in a prospective multicenter registry, and who underwent either PI (n = 269) or pPCI (n = 2,572), were analyzed. The primary end point was in-hospital major adverse cardiovascular events (MACE) defined as the composite of all-cause mortality, nonfatal MI, stroke, and definite stent thrombosis. Secondary end points included all-cause death, major bleeding, net adverse clinical events, and the development of in-hospital Killip class III or IV heart failure. Propensity-score matching and conditional logistic regression were used to adjust for confounders. Within the matched cohort, rates of MACE was not statistically different between the PI (n = 247) and pPCI (n = 958) groups, (11.3% vs 9.0%, respectively, odds ratio 1.25, 95% confidence interval 0.81 to 1.94; p = 0.31). Secondary end points were comparable between groups at the exception of a lower rate of development of Killip class III or IV heart failure after PI. The rate of intracranial hemorrhage was significantly higher in the PI group (2.3% vs 0.0%, p = 0.03). In conclusion, the present study demonstrated no difference regarding in-hospital MACE following PI or pPCI in STEMI patients ≥70 years of age. An adequately-powered randomized trial is needed to precisely define the role of PI in this high-risk subgroup. SN - 1879-1913 UR - https://www.unboundmedicine.com/medline/citation/31685213/Pharmacoinvasive_Strategy_Versus_Primary_Percutaneous_Coronary_Intervention_for_ST-Segment_Elevation_Myocardial_Infarction_in_Patients_≥70_Years_of_Age L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9149(19)31113-0 DB - PRIME DP - Unbound Medicine ER -