Universität zu Köln

Macherey‐Meyer, Sascha ORCID: 0000-0002-7080-6611, Dilley, David, Heyne, Sebastian ORCID: 0000-0002-1581-9954, Meertens, Max Maria ORCID: 0000-0002-7746-8723, Nies, Richard Julius ORCID: 0000-0002-1336-6031, Lee, Samuel ORCID: 0000-0001-6768-7079, Adler, Christoph ORCID: 0000-0002-1045-2743, Baldus, Stephan ORCID: 0000-0001-8259-1737, Eitel, Ingo ORCID: 0000-0002-6442-246X, Stiermaier, Thomas ORCID: 0000-0003-1957-3741, Frerker, Christian ORCID: 0000-0003-0226-0888 and Schmidt, Tobias (2025). Invasive Strategy With Intended Percutaneous Coronary Intervention Versus Conservative Treatment in Older People With ST‐Segment–Elevation Myocardial Infarction: A Meta‐Analysis. Journal of the American Heart Association, 14 (8). pp. 1-14. Wiley. ISSN 2047-9980

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Abstract

Background: Patients ≥80 years old were underrepresented or excluded from landmark trials demonstrating the superiority of primary percutaneous coronary intervention (PCI) in ST‐segment–elevation myocardial infarction. The current meta‐analysis assessed the effects of an invasive strategy with intended PCI compared with conservative treatment in older people (≥80 years) with ST‐segment–elevation myocardial infarction. Methods: A structured literature search was performed. The primary outcome was overall survival. Secondary outcome analyses included but were not limited to 30‐day and 1‐year mortality. Results: Thirteen studies reporting on 102 158 older adults were included. Of these, 31 629 (31%) were assigned to PCI and 70 529 (69%) were treated conservatively. The overall survival was 76.5% in PCI and 67.2% in conservative treatment at the time of longest available follow‐up (odds ratio [OR], 2.18 [95% CI, 1.79–2.66], P <0.001, I 2 =88%, favoring PCI). The follow‐up period ranged from 30 days to 26.5 months. The 30‐day. (OR, 0.39 [95% CI, 0.31–0.50], P <0.001, I 2 =0%) and 1‐year mortality (OR, 0·34 [95% CI, 0.25–0.46], P <0.001, I 2 =0%), were lower in the PCI group. Conclusions: This meta‐analysis indicates a potential underuse of PCI in older adults with ST‐segment–elevation myocardial infarction. PCI was advantageous in short‐ and long‐term survival, but these results were affected by confounding. Nonetheless, every second patient not referred for invasive treatment survived at least 1 year. These findings have hypothesis generating implications, but they indicate ageism and emphasize that PCI should not be automatically withheld in older patients.

Item Type:	Article
Creators:	Creators Email ORCID ORCID Put Code Macherey‐Meyer, Sascha UNSPECIFIED https://orcid.org/0000-0002-7080-6611 UNSPECIFIED Dilley, David UNSPECIFIED UNSPECIFIED UNSPECIFIED Heyne, Sebastian UNSPECIFIED https://orcid.org/0000-0002-1581-9954 UNSPECIFIED Meertens, Max Maria UNSPECIFIED https://orcid.org/0000-0002-7746-8723 UNSPECIFIED Nies, Richard Julius UNSPECIFIED https://orcid.org/0000-0002-1336-6031 UNSPECIFIED Lee, Samuel UNSPECIFIED https://orcid.org/0000-0001-6768-7079 UNSPECIFIED Adler, Christoph UNSPECIFIED https://orcid.org/0000-0002-1045-2743 UNSPECIFIED Baldus, Stephan UNSPECIFIED https://orcid.org/0000-0001-8259-1737 UNSPECIFIED Eitel, Ingo UNSPECIFIED https://orcid.org/0000-0002-6442-246X UNSPECIFIED Stiermaier, Thomas UNSPECIFIED https://orcid.org/0000-0003-1957-3741 UNSPECIFIED Frerker, Christian UNSPECIFIED https://orcid.org/0000-0003-0226-0888 UNSPECIFIED Schmidt, Tobias UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-792292
Identification Number:	10.1161/JAHA.124.040435
Journal or Publication Title:	Journal of the American Heart Association
Volume:	14
Number:	8
Page Range:	pp. 1-14
Date:	15 April 2025
Publisher:	Wiley
ISSN:	2047-9980
Language:	English
Faculty:	Faculty of Medicine
Divisions:	Faculty of Medicine > Innere Medizin > Klinik III für Innere Medizin - Kardiologie, Pneumologie, Angiologie und internistische Intensivmedizin
Subjects:	Medical sciences Medicine
['eprint_fieldname_oa_funders' not defined]:	Publikationsfonds UzK
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/79229