Table 1.
Reported outcomes of older adults in selected randomized trials of percutaneous coronary intervention.
| Trial (condition) | Strategy | Exclusions | Older adults | Outcome in older adults | Ref. |
|---|---|---|---|---|---|
| FRISC II (UA/NSTEMI) | Early angiography ± revascularization vs medical therapy | Age ≥ 75 years Creatinine >1.7 mg/dl High bleeding risk PCI within 6 months Osteoporosis |
53% 65–74 years | 1-year death or nonfatal MI: significant benefit with early angiography in patients 65–74 years (RR = 0.63) | [96] |
| TACTICS-TIMI 18 (UA/NSTEMI) | Early angiography ± revascularization vs medical therapy | Creatinine >2.5 mg/dl Prior GI bleeding CVA within 1 year Cardiogenic shock |
43% ≥ 65 years | 30-day mortality, nonfatal MI or rehospitalization: significant benefit with early angiography in patients ≥ 65 years (OR = 0.59) | [31] |
| GUSTO IIb (STEMI) | PCI vs fibrinolysis (TPA) | Creatinine >2.0 mg/dl Active bleeding Prior CVA On Coumadin® |
26% >70 years | 30-day mortality: trend towards benefit with PCI in patients >70 years | [97] |
| DANAMI-2 (STEMI) | PCI vs fibrinolysis (alteplase) | Creatinine >2.8 mg/dl On metformin Cardiogenic shock Prior CABG Life expectancy <1 year |
50% >63 years 25% >73 years |
30-day mortality, nonfatal MI or stroke: significant benefit with PCI in patients >63 years (OR = 0.54) | [98] |
| SHOCK (STEMI + shock) | Emergent PCI vs initial medical stabilization | Noncardiogenic shock Severe systemic illness Severe valvular disease |
19% ≥75 years | 30-day mortality: trend towards harm with PCI in patients ≥ 75 years | [99] |
Revascularization = PCI or CABG where appropriate.
CABG: Coronary artery bypass grafting; CVA: Cerebrovascular accident (stroke/transient ischemic attack); DANAMI: Danish Multicenter Randomized Study on Thrombolytic Therapy Versus Acute Coronary Angioplasty in Acute Myocardial Infarction; FRISC II: Framingham and Fast Revascularization During Instability in Coronary Artery Disease II; GI: Gastrointestinal; GUSTO IIb: Global Use of Strategies to Open Occluded Coronary Arteries IIb; MI: Myocardial infarction; NSTEMI: Non-ST elevation myocardial infarction; OR: Odds ratio; PCI: Percutaneous coronary intervention; RR: Relative risk; SHOCK: Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock; STEMI: ST elevation myocardial infarction; TACTICS-TIMI: Treat Angina with Aggrastat and Determine Cost of Therapy with Invasive or Conservative Strategy – Thrombolysis In Myocardial Infarction; TPA: Tissue plasminogen activator; UA: Unstable angina.