The impact of age and Killip class on outcomes of primary percutaneous coronary intervention. insight from the PRAGUE-1 and -2 trials and registry

Background: Primary PCl (p-PCl) was shown to be the most effective reperfusion strategy for ST segment elevation myocardial infarction (STEMI). However, its success rates and clinical outcomes among the elderly patients are less well defined. The aim of this work was to access, whether primary PCl, as compared to thrombolysis, improves the outcomes of elderly patients with STEMI to the same extent as in the younger patient groups and whether this holds true also for the elderly patients presenting in cardiogenic shock or acute heart failure. Patients: A total of 2,073 patients were analysed: 1,050 were enrolled in the randomised trials PRAGUE-1 and -2 and 1,023 entered a p-PCI registry at our institution. The mean age was 64 years, 29% were females. Three hundred and ninety patients were in the elderlyl (≥ 75 years) age group, 605 patients were aged 65-74 years and 1,078 patients were <65 years old. Acute heart failure was more prevalent in the patients that entered in the registry as compared to the randomised patients: Killip class IV 10% vs 1% (p < 0.001), Killip II-III class 29% vs 18% (p < 0.001). Results: An optimal PCl result was achieved in 81% of the elderly and 90% of the younger patients (p < 0.001). The absolute mortality reduction by p-PCI compared to thrombolysis was 5.7% in the elderly and 3.7% in the younger groups (n.s.). The in-hospital mortality of Killip IV patients was 69% (elderly group), 54% (group 65-74 years, p < 0.001) and 27% (group <65 years, p < 0.001). The in-hospital mortality of patients without cardiogenic shock was low in all age groups: 4% (elderly), 2.7% (65-74 years) and 0.8% (<65 years). Conclusion: Primary PCl is the most effective reperfusion strategy for the elderly patients presenting with STEMI.