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. 2015 Mar;12(2):174–184. doi: 10.11909/j.issn.1671-5411.2015.02.012

Table 1. Key studies of primary PCI in the elderly and very elderly with STEMI.

Study name Nature of study Number of patients Main results Study limitations
TRIANA[67] (RCT) PPCI vs. Fibrinolysis in patients ≥ 75 years 266 Primary endpoint (30-day death, re-infarction, or disabling stroke) was achieved in 18.9% of patients treated with PPCI when compared with 25.4% of the patients thrombolysed (P = 0.43), with no significant difference in complication like major hemorrhage, blood transfusion or renal failure.
Benefits were persistent at the end of one year with a significant reduction in recurrent ischemia (0.8% vs. 11.9%; P < 0.001) in the PCI arm.
Halted prematurely due to slow recruitment.
Primary endpoint underpowered.
Healthier population enrolled with considerable exclusion of patients with comorbidities, limiting extrapolation to broader populations.
Western Denmark Heart Registry[68] Analysis of octo- & Nonagenarians undergoing PPCI from health care database 1322 Annual proportion of octogenarians undergoing PPCI doubled during the study period (2002–2009).
Overall 30-day mortality was 17.9%, while the 1-year cumulative mortality was 27.2% and 5-year cumulative mortality was 41.1%.
Acceptable outcome with a 5-year survival of more than 50% in octogenarians and nonagenarians.
Non-randomized trial.
Study focused on mortality rates, however no breakdown of cause of death provided.
Other endpoints like MI, bleeding complications and renal failure after PPCI not assessed.
SENIOR PAMI[80](RCT) PPCI vs. Fibrinolysis in patients ≥ 70 years 481 PPCI was superior to thrombolytic therapy (11.6% vs. 18.0%, P = 0.005) at reducing the combined secondary endpoint of death/CVA/re-infarction at 30 days.
PPCI did not reduce the primary endpoint of 30-day death or disabling stroke (11.3% vs. 13%, P = 0.57).
Study was stopped prematurely due to recruitment issues.
Primary endpoint not statistically significant due to insufficient sample size.
PCAT-2[81](Meta-analysis of 22 RCTs) PPCI vs. Fibrinolysis 410 octogenarians of the 6763 patients studied Octogenarians undergoing PPCI had a lower incidence of all-cause mortality (18.3% vs. 26.4%, P = 0.04) at 30-day follow-up compared to those who were thrombolysed. Elderly patients included in these trials form a selected group, hence the observed favorable effects might not be fully extrapolated to the general population.

CVA: cerebrovascular accident; HF: heart failure; PAMI: primary angioplasty in myocardial infarction; PCI: percutaneous coronary intervention; PPCI: primary percutaneous coronary intervention; RCT: randomized controlled trial.