CMAJ: PCI for seniors increase over last decade; may help survival

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For acute MI patients aged 80 and over, primary PCI and other revascularization methods are now becoming an option and being more widely utilized. While performing interventions in this population can produce better long-term outcomes and one-year survival rates, researchers suggested further studies are needed to determine the cost effectiveness of their increased use, according to a study published in the Aug. 3 edition of the Canadian Medical Association Journal.

Because results of previous studies have shown the increased benefit of performing invasive procedures on the elderly, Maude Page, MD, of the Hôpital du Sacré-Coeur de Montréal, Université de Montréal, and colleagues used the Med-Echo database of hospital discharges in Quebec to identify acute MI patients, aged 80 and older between March 30, 1996, and March 30, 2007. Thirty-day rates of PCI and 90-day rates of CABG were assessed.

The researchers identified 29,750 patients 80 or over with acute MI—3,683 (12.4 percent) underwent PCI within 30 days and 743 (2.5 percent) underwent CABG within 90 days. Of the 25,363 who did not receive PCI or CABG, 486 had a late revascularization procedure within one year of MI.

The researchers found that the rate of PCI interventions within this subset of patients increased 12-fold.

Page and colleagues found that there was a 22.7 percent increase in the rate of PCI procedures performed between 1996 and 2007. The rate at which PCI was performed within the same day or day after the admission increased by 12.9 percent beginning in 2001.

The researchers noted that ACE inhibitor, angiotensin II receptor antagonists (ARBs), antiplatelet drugs, beta-blockers and statin use increased between 2003 and 2006.

From 1996 to 2006, the rate of one-year mortality subsequent to acute MI decreased from 48.4 percent to 39 percent and for those who underwent PCI within 30 days of MI, rates of one-year mortality improved, but stabilized in 2001.

Compared to the later years of the study period (2003-2006), 30-day mortality rates decreased from the earlier years (1996-1996) from 30.4 percent to 23.5 percent, respectively.

“Our study shows that there were important temporal changes in practice patterns concerning the management of MI in the very elderly populations,” the authors wrote. “Our data also suggest that there has been a major change in the management strategy of MI in the very elderly during the turn of the century, with use of early PCI interventions performed on the first day of actue MI.”

During the study, the researchers also found an increase in the number of patients undergoing PCI and CABG with comorbidities. The authors attributed this rise of comorbidities to advances in the management of these conditions and to the fact that high-risk patients are more quickly being referred to the hospital and are more likely to reach the hospital before dying.

“Substantial numbers of revascularization procedures are now being performed in very old patients for whom such procedures were not even considered a decade ago,” the authors noted. “In the context of an aging population and limited healthcare resources, it is imperative to determine whether such drastic changes in practice are cost effective.”