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dc.contributor.authorMehta, Rajendra H.
dc.contributor.authorSadiq, Immad
dc.contributor.authorGoldberg, Robert J.
dc.contributor.authorGore, Joel M.
dc.contributor.authorAvezum, Alvaro
dc.contributor.authorSpencer, Frederick A.
dc.contributor.authorKline-Rogers, Eva M.
dc.contributor.authorAllegrone, Jeanna
dc.contributor.authorPieper, Karen S.
dc.contributor.authorFox, Keith A. A.
dc.contributor.authorEagle, Kim A.
dc.contributor.authorGRACE Investigators
dc.date2022-08-11T08:08:09.000
dc.date.accessioned2022-08-23T15:44:11Z
dc.date.available2022-08-23T15:44:11Z
dc.date.issued2004-02-05
dc.date.submitted2011-09-23
dc.identifier.citationAm Heart J. 2004 Feb;147(2):253-9. <a href="http://dx.doi.org/10.1016/j.ahj.2003.08.007">Link to article on publisher's site</a>
dc.identifier.issn0002-8703 (Linking)
dc.identifier.doi10.1016/j.ahj.2003.08.007
dc.identifier.pmid14760322
dc.identifier.urihttp://hdl.handle.net/20.500.14038/27259
dc.description.abstractBACKGROUND: Few data exist from a community-based perspective on the relative effectiveness of primary percutaneous coronary intervention (PCI) as compared with thrombolytic therapy (TT) in elderly patients with ST-elevation myocardial infarction (STEMI), particularly in the current era of coronary stents and newer antithrombotic agents. METHODS: We evaluated data from patients, aged > or =70 years, with STEMI who were enrolled in the Global Registry of Acute Coronary Events study between April 1999, and September 2002. RESULTS: Of the 2975 elderly patients eligible for reperfusion therapy, 365 (12.7%) underwent primary PCI and 769 (26.7%) received TT. The median delay from hospital arrival to therapy was 105 minutes for primary PCI and 40 minutes for TT. Inhospital complications for primary PCI versus TT included mortality (13.5% vs 14.8%), reinfarction (1.1% vs 5.7%), composite of death or reinfarction (14.3% vs 18.7%), cardiogenic shock (11.3% vs 11.6%), major bleeding (8.6% vs 5.9%), and stroke (1.1% vs 2.8%). After adjustment for baseline differences and propensity score, patients receiving primary PCI showed a lower rate of reinfarction (odds ratio [OR], 0.15; 95% CI, 0.05-0.44) and mortality (OR, 0.62; 95% CI, 0.39-0.96) and the composite of reinfarction or death (OR, 0.53; 95% CI, 0.35-0.79), with no difference in other outcome measures. CONCLUSION: Our data suggest that, compared with TT, primary PCI is associated with a decrease in reinfarction and mortality, with no change in other outcome measures, in elderly patients with STEMI. These findings from an observational registry require further confirmation in future randomized clinical trial assessing the optimal reperfusion strategy in the elderly cohort with STEMI.
dc.language.isoen_US
dc.relation<a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&list_uids=14760322&dopt=Abstract">Link to Article in PubMed</a>
dc.relation.urlhttp://dx.doi.org/10.1016/j.ahj.2003.08.007
dc.subjectAged
dc.subject*Angioplasty, Balloon, Coronary
dc.subjectElectrocardiography
dc.subjectHemorrhage
dc.subjectHospital Mortality
dc.subjectHumans
dc.subjectMyocardial Infarction
dc.subjectOdds Ratio
dc.subjectRecurrence
dc.subjectRegistries
dc.subjectStents
dc.subjectStreptokinase
dc.subjectStroke
dc.subject*Thrombolytic Therapy
dc.subjectHealth Services Research
dc.titleEffectiveness of primary percutaneous coronary intervention compared with that of thrombolytic therapy in elderly patients with acute myocardial infarction
dc.typeJournal Article
dc.source.journaltitleAmerican heart journal
dc.source.volume147
dc.source.issue2
dc.identifier.legacycoverpagehttps://escholarship.umassmed.edu/cor_grace/77
dc.identifier.contextkey2254998
html.description.abstract<p>BACKGROUND: Few data exist from a community-based perspective on the relative effectiveness of primary percutaneous coronary intervention (PCI) as compared with thrombolytic therapy (TT) in elderly patients with ST-elevation myocardial infarction (STEMI), particularly in the current era of coronary stents and newer antithrombotic agents.</p> <p>METHODS: We evaluated data from patients, aged > or =70 years, with STEMI who were enrolled in the Global Registry of Acute Coronary Events study between April 1999, and September 2002.</p> <p>RESULTS: Of the 2975 elderly patients eligible for reperfusion therapy, 365 (12.7%) underwent primary PCI and 769 (26.7%) received TT. The median delay from hospital arrival to therapy was 105 minutes for primary PCI and 40 minutes for TT. Inhospital complications for primary PCI versus TT included mortality (13.5% vs 14.8%), reinfarction (1.1% vs 5.7%), composite of death or reinfarction (14.3% vs 18.7%), cardiogenic shock (11.3% vs 11.6%), major bleeding (8.6% vs 5.9%), and stroke (1.1% vs 2.8%). After adjustment for baseline differences and propensity score, patients receiving primary PCI showed a lower rate of reinfarction (odds ratio [OR], 0.15; 95% CI, 0.05-0.44) and mortality (OR, 0.62; 95% CI, 0.39-0.96) and the composite of reinfarction or death (OR, 0.53; 95% CI, 0.35-0.79), with no difference in other outcome measures.</p> <p>CONCLUSION: Our data suggest that, compared with TT, primary PCI is associated with a decrease in reinfarction and mortality, with no change in other outcome measures, in elderly patients with STEMI. These findings from an observational registry require further confirmation in future randomized clinical trial assessing the optimal reperfusion strategy in the elderly cohort with STEMI.</p>
dc.identifier.submissionpathcor_grace/77
dc.contributor.departmentDepartment of Medicine, Division of Cardiovascular Medicine
dc.contributor.departmentCenter for Outcomes Research
dc.source.pages253-9


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