Revascularisation Superior to Medical Therapy in Very Elderly Patients With Acute MI, Renal Dysfunction

October 21, 2020

By Eric Ramos

CHICAGO -- October 20, 2020 -- Revascularisation with percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) is superior to medical therapy alone in very elderly patients with baseline renal dysfunction presenting with acute myocardial infarction (MI), according to a study presented at TCT Connect, the 2020 Virtual Transcatheter Cardiovascular Therapeutics Meeting.

“Very elderly patients are largely under-represented in randomised clinical trials,” said Derek Q. Phan, MD, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California. “Either strategy may be appropriate in this high-risk population.”

For the study, the researchers analysed data from patients aged 80 years and older with a glomerular filtration rate

A total of 423 patients underwent PCI, 94 underwent CABG, and 347 received medical therapy alone. The 3 groups were well-balanced with respect to baseline characteristics and comorbidities, although those treated with medical therapy were more likely to be Black, had ≥1 chronic total occlusions in any vessel, and had lower left ventricular ejection fraction.

Compared with medical therapy alone, revascularisation -- either PCI or CABG -- was associated with a 34% reduced mortality risk (hazard ratio [HR] = 0.66; 95% confidence interval [CI], 0.60-0.73) and a 32% reduced risk for nonfatal MI (HR = 0.68; 95% CI, 0.58-0.78).

However, there was an increased need for repeated revascularisation in this group compared with medical therapy alone (HR = 1.60; 95% CI, 1.15-2.23).

The HR for all-cause mortality for PCI versus medical therapy was 0.75 (95% CI, 0.66-0.86), 0.70 (95% CI, 0.59-0.83) for CABG versus medical therapy, and 1.04 (95% CI, 0.86-1.25) for PCI versus CABG.

“Revascularisation was associated with lower mortality in all subgroups, except in Black patients and those with prior CABG,” said Dr. Phan. “Age alone should not preclude patients from potentially beneficial invasive therapies.”

[Presentation title: Revascularization in Very Elderly Patients With Baseline Renal Dysfunction Presenting With Acute Myocardial Infarction. Abstract TCT-021]