Abstract 16311: Differential Outcomes of Primary Percutaneous Coronary Intervention Compared to Medical Management Alone for Very Elderly Patients With ST-Elevation and Non-ST-Elevation Myocardial Infarctions - A Systematic Review and Meta-Analysis

Introduction: ST-segment elevation myocardial infarction (STEMI) and NSTEMI in elderly are therapeutic challenges as percutaneous coronary intervention (PCI) is often withheld owing to concern for side effects. It is also unsure if outcomes vary for these two syndromes.

Hypothesis: PCI is better than conservative medical therapy (CMT) in very elderly patients (age > 80 years) and if such results vary with presence of transmural infarction.

Methods: PubMed, Embase, Cochrane database and clinicaltrials.gov were searched for relevant studies. The primary end point was mortality outcomes for both syndromes and secondary outcomes included short and long term major adverse cardiovascular events (MACE) and bleeding events for NSTEMI patients.

Results: Nine STEMI studies with N= 1528 (PCI= 1119, CMT= 409) and eleven NSTEMI studies with N= 36089 (PCI= 9770 , CMT= 26319) were included. For STEMI patients, PCI showed significantly better 30-day [RR= 0.35 (0.22-0.56), p= 0.01, I ² =60.08], one-year [RR= 0.28 (0.17-0.47), p= 0.001, I ² = 68.36] and long-term mortality [RR= 0.40 (0.12- 1.36), p= 0.001, I ² =86.07]. These outcomes did not replicate in NSTEMI patients for whom no difference was found for in-hospital mortality [RR= 0.44 (0.17- 1.16), p= 0.08, I ² = 59.9] and 30-days all-cause mortality [RR= 0.32 (0.29- 0.36), p=0.53, I ² = 0.0]. However, 12-month outcomes were better with PCI for all-cause mortality [RR= 0.29 (0.23- 0.37), p< 0.001, I ² = 81.32] and MACE [RR= 0.44 (0.21-0.87), p=0.001, I ² = 84]. The short-term bleeding risk seemed lower with CMT [RR=1.29 (0.56-3.09), p< 0.001, I ² =90.4] without any long-term bleeding difference [RR= 1.85 (0.21-16.24), p < 0.001, I ² = 99.2] though large heterogeneity and wide confidence intervals limit definite conclusions.

Conclusions: PCI has significant mortality benefits especially for STEMI patients. For NSTEMI patients undergoing PCI, the extended mortality risk improves without concurrent increment in major bleeding risk.