Sanneke P.M. de Boer, Cynthia M. Westerhout, R. John Simes, Christopher B. Granger, Felix Zijlstra, Eric Boersma, for the PCAT-2 (Primary Coronary Angioplasty Versus Thrombolysis-2) Trialists Collaborators Group, Erasmus Medical Center, Rotterdam, the Netherlands, University of Alberta, Edmonton, Alberta, Canada, National Health and Medical Research Council Clinical Trials Centre, Sydney, Australia, Duke University Medical Center, Durham, North Carolina, Universitair Medisch Centrum Groningen, Groningen, the Netherlands.
OBJECTIVES: The aim of this study was to obtain a valid estimate of the clinical effects of primary percutaneous coronary intervention (PPCI) in relation to age.
BACKGROUND: Treatment with PPCI is most beneficial in high-risk myocardial infarction patients. Paradoxically, elderly patients, who are at increased risk of adverse outcome, are often withheld PPCI.
METHODS: Individual patient data were obtained from 22 randomized trials (n = 6,763) evaluating the clinical effects of PPCI versus fibrinolysis (FL). Differences in 30-day death, repeat myocardial infarction, and stroke between patients randomized to FL and PPCI were determined in 5 age-strata: 50, >50 to 60, >60 to 70, >70 to 80, and >80 years. Treatment effects are reported as odds ratios (ORs) and 95% confidence intervals (CI). Multivariable logistic regression analyses, which included age x treatment interaction, were applied to examine evidence of heterogeneity in age-specific ORs.
RESULTS: Thirty-day death increased with increasing age and ranged from 1.1% (FL) and 1.8% (PPCI) in patients 50 years to 26.4% and 18.3% in patients >80 years of age. The point estimate of treatment effect (overall adjusted OR: 0.65; 95% CI: 0.52 to 0.79) was compatible with a mortality reduction favoring PPCI in all age-strata (except in patients 50 years of age), and 95% CIs were largely overlapping. There was no evidence of heterogeneity in ORs between age categories. Similar results were observed for repeat myocardial infarction and stroke.
CONCLUSIONS: In this analysis of randomized trials, the reduction in clinical end points by PPCI was not influenced by age. Hence, age per se should not be considered an exclusion criterion for the application of PPCI.
J Am Coll Cardiol Intv, 2010; 3:324-331