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.