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Pharmacoinvasive Strategy Versus Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction in Patients ≥70 Years of Age.
Auffret, Vincent; Laurin, Clément; Leurent, Guillaume; Didier, Romain; Filippi, Emmanuelle; Hacot, Jean-Philippe; Zabalawi, Amer; Rouault, Gilles; Saouli, Djamel; Druelles, Philippe; Coudert, Isabelle; Boulanger, Bertrand; Bot, Emilie; Treuil, Josiane; Bedossa, Marc; Boulmier, Dominique; Loirat, Aurélie; Sharobeem, Sam; Guellec, Marielle Le; Gilard, Martine; Breton, Hervé Le.
Afiliación
  • Auffret V; 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:
  • Laurin C; 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 Cardio
  • Leurent G; 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.
  • Didier R; Department of Cardiology, La Cavale Blanche University Hospital, Optimization of physiological Regulations, Science and Technical Training and ResearchUnit, Brest, France.
  • Filippi E; Department of Cardiology, General Hospital of Atlantic Brittany, Vannes, France.
  • Hacot JP; Department of Cardiology, General Hospital of South Brittany, Lorient, France.
  • Zabalawi A; Department of Cardiology, General Hospital Yves Le Foll, St-Brieuc, France.
  • Rouault G; Department of Cardiology, General Hospital René Théophile Laennec, Quimper, France.
  • Saouli D; Department of Cardiology, General Hospital Broussais, St-Malo, France.
  • Druelles P; Department of Cardiology, Clinic St-Laurent, Rennes, France.
  • Coudert I; Department of Medical Emergency, General Hospital Yves Le Foll, St-Brieuc, France.
  • Boulanger B; Department of Medical Emergency, General Hospital of Atlantic Brittany, Vannes, France.
  • Bot E; Department of Medical Emergency, Pontchaillou University Hospital, Rennes, France.
  • Treuil J; Department of Medical Emergency, La Cavale Blanche University Hospital, Brest, France.
  • Bedossa M; 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.
  • Boulmier D; 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.
  • Loirat A; 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.
  • Sharobeem S; Center for Clinical Investigation 804, Signal and Image Treatment laboratory (LTSI), National Institute of Health and Medical Research U1099, Rennes, France.
  • Guellec ML; 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.
  • Gilard M; Department of Cardiology, La Cavale Blanche University Hospital, Optimization of physiological Regulations, Science and Technical Training and ResearchUnit, Brest, France.
  • Breton HL; 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.
Am J Cardiol ; 125(1): 1-10, 2020 01 01.
Article en En | MEDLINE | ID: mdl-31685213
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.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Terapia Trombolítica / Sistema de Registros / Guías de Práctica Clínica como Asunto / Intervención Coronaria Percutánea / Infarto del Miocardio con Elevación del ST Tipo de estudio: Clinical_trials / Etiology_studies / Guideline / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Aged80 / Female / Humans / Male País/Región como asunto: Europa Idioma: En Revista: Am J Cardiol Año: 2020 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Terapia Trombolítica / Sistema de Registros / Guías de Práctica Clínica como Asunto / Intervención Coronaria Percutánea / Infarto del Miocardio con Elevación del ST Tipo de estudio: Clinical_trials / Etiology_studies / Guideline / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Aged80 / Female / Humans / Male País/Región como asunto: Europa Idioma: En Revista: Am J Cardiol Año: 2020 Tipo del documento: Article Pais de publicación: Estados Unidos