Macherey-Meyer Sascha, Dilley David, Heyne Sebastian, Meertens Max Maria, Nies Richard Julius, Lee Samuel, Adler Christoph, Baldus Stephan, Eitel Ingo, Stiermaier Thomas, Frerker Christian, Schmidt Tobias
Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine University of Cologne Cologne Germany.
Faculty of Medicine University Schleswig-Holstein, University Hospital Lübeck Lübeck Germany.
J Am Heart Assoc. 2025 Apr 15;14(8):e040435. doi: 10.1161/JAHA.124.040435. Epub 2025 Apr 10.
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.
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.
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], <0.001, =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], <0.001, =0%) and 1-year mortality (OR, 0·34 [95% CI, 0.25-0.46], <0.001, =0%), were lower in the PCI group.
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.
在证明直接经皮冠状动脉介入治疗（PCI）在ST段抬高型心肌梗死中的优越性的里程碑式试验中，80岁及以上的患者代表性不足或被排除在外。当前的荟萃分析评估了在年龄较大（≥80岁）的ST段抬高型心肌梗死患者中，与保守治疗相比，意向性PCI的侵入性策略的效果。
进行了结构化文献检索。主要结局是总体生存率。次要结局分析包括但不限于30天和1年死亡率。
纳入了13项报告102158名老年人的研究。其中，31629名（31%）被分配接受PCI治疗，70529名（69%）接受保守治疗。在最长可用随访时，PCI组的总体生存率为76.5%，保守治疗组为67.2%（优势比[OR]，2.18[95%CI，1.79 - 2.66]，<0.001，I² = 88%，支持PCI）。随访期从30天到26.5个月不等。PCI组的30天死亡率（OR，0.39[95%CI，0.31 - 0.50]，<0.001，I² = 0%）和1年死亡率（OR，0.34[95%CI，0.25 - 0.46]，<0.001，I² = 0%）较低。
这项荟萃分析表明，在年龄较大的ST段抬高型心肌梗死患者中，PCI可能未得到充分应用。PCI在短期和长期生存方面具有优势，但这些结果受到混杂因素的影响。尽管如此，每两名未接受侵入性治疗的患者中就有一名至少存活了1年。这些发现具有产生假设的意义，但它们表明了年龄歧视，并强调在老年患者中不应自动拒绝PCI治疗。
