Comparison of transradial and transfemoral coronary intervention in octogenarians with acute myocardial infarction

A Propensity Score Matching Analysis of Transradial Versus Transfemoral Approaches in Octogenarians Undergoing Percutaneous Coronary Intervention

Background

Despite the widespread adoption of the transradial approach for elderly patients undergoing percutaneous coronary intervention (PCI) in clinical practice, data on octogenarians in China are still relatively limited. This study sought to compare both the safety and efficacy of transradial intervention (TRI) and transfemoral intervention (TFI) in octogenarians in China.

Methods

We identified 254 octogenarians who underwent PCIs in Fuwai Hospital, Beijing, China between January 1, 2006 and April 30, 2011. TRI was used in 184 patients and TFI was used in 70 patients. Incidence rates of in- hospital and 1-year clinical outcomes were compared between the two groups. Ono-to-one propensity score matching (PSM) was performed to control for potential bias. A total of 48 pairs were matched.

Results

Baseline and procedural characteristics were balanced between the TRI and TFI groups. Patients undergoing TRI had significantly fewer access site complications (10.3% vs. 20.0%, p = 0.040), although this difference did not remain significant in propensity score-matched patients (10.4% vs. 22.9%, p = 0.100). After PSM, the patients undergoing TRI were less likely to have major post-PCI bleeding (0 vs. 12.5%, odds ratio 0.47, 95% confidence interval 0.37-0.58, p = 0.026). There were no statistical differences in the incidence rates of major adverse cardiac events (a composite of cardiac death, myocardial infarction, and target vessel revascularization) and their components both during hospitalization and at 1-year.

Conclusions

Compared with TFI, TRI was safer and more feasible for octogenarians undergoing PCI.

Current status of acute myocardial infarction in Korea

Coronary artery disease, especially acute myocardial infarction (AMI), is a leading cause of death in the Asia-Pacific region. The Korea Acute Myocardial Infarction Registry (KAMIR) is the first nationwide, prospective, multicenter registry of Korean patients with AMI. Since the KAMIR first began in November 2005, more than 70,000 patients have been enrolled, and 230 papers have been published (as of October 2018). Moreover, published data from the KAMIR have revealed different characteristics from those of Western AMI registries regarding risk factors, interventional strategies, and clinical outcomes. As a result, the KAMIR study has improved the outcomes of percutaneous coronary intervention and reduced mortality. We propose the use of the KAMIR score in the prediction of 1-year mortality. Using data from the KAMIR, we provide an overview of the current status of AMI in Korea, including trends in demographic characteristics, risk factors, medications, treatment strategies, and clinical outcomes.

A Comparison of Transradial and Transfemoral Percutaneous Coronary Intervention in Chinese Women Based on a Propensity Score Analysis

Background and Objectives

Over the past decades, transradial approach for percutaneous coronary intervention (PCI) has been increasingly adopted in clinical practice. Women represent a large population who will possibly benefit from PCI, but they are often under-represented in clinical studies. Therefore, the role of TRI in women remains to be further defined. This study sought to compare safety and efficacy for transradial intervention (TRI) and transfemoral intervention (TFI) in women undergoing PCI in China.

Methods

The study population consisted of 5,067 women undergoing PCI at Fuwai Hospital, Beijing, China between 2006 and 2011 (TRI: n=4,105, TFI: n=962). Incidence rates of clinical outcomes during hospitalization and at 1-year follow-up were compared between TRI and TFI. In order to minimize potential biases, a 1:1 propensity score matching (PSM) was performed. A total of 899 pairs were matched.

Results

Baseline and procedural characteristics were well-balanced between TRI and TFI groups after controlling for confounders using PSM. TRI was associated with reduced major post-PCI bleeding (odds ratio [OR], 0.64; 95% confidence interval [CI], 0.54–0.76; p<0.001) and access site complications (OR, 0.67; 95% CI, 0.61–0.74; p<0.001) after PSM. There was no statistical differences in the incidence rates of major adverse cardiac events (a composite of cardiac death, myocardial infarction, and target vessel revascularization) both during hospitalization and at 1-year follow-up (p>0.05).

Conclusions

In this propensity score-based analysis of TRI versus TFI in Chinese women, TRI showed advantages of safety and feasibility over TFI. A wider adoption of TRI in women has the potential to improve outcomes in treatment of coronary artery diseases.

Results of a 10-Year Experience in Korea Using Drug-Eluting Stents During Percutaneous Coronary Intervention for Acute Myocardial Infarction (from the Korea Acute Myocardial Infarction Registry)

Limited information exists about characteristics of patients with acute myocardial infarction (AMI) in Asia. We examined trends in interventional treatment and clinical outcomes for AMI from the Korea Acute Myocardial Infarction Registry (KAMIR). The study population was derived from patients in the KAMIR from November 2005 to December 2016. We identified 54,402 patients with ST-elevation myocardial infarction (STEMI) (n = 29,222) and non-ST-elevation myocardial infarction (NSTEMI) (n = 25,180). The rate of percutaneous coronary intervention (PCI) increased to 96.2% of STEMI group and 84.3% of NSTEMI group in 2016, respectively (All p_trend <0.001). Furthermore, the rate of successful PCI was 97.3% in STEMI and 97.9% in NSTEMI. The rate of primary PCI increased from 67.8% in 2005 to 96.9% in 2016 (p_trend <0.001). Moreover, in patients with STEMI, the proportion of drug-eluting stent implantation increased from 88.8% in 2005 to 97.9% in 2016 (p_trend <0.001). Regarding 1-year clinical outcomes, incidence of definite stent thrombosis was 0.5%, 0.6%, and 0.4% in patients with AMI, STEMI, and NSTEMI, respectively. Moreover, 1-year mortality of AMI improved almost 40% compared with in 2005 (11.4% in 2005 and 6.7% in 2015, p_trend <0.001). In Korean patients with AMI, the rate of primary PCI and drug-eluting stent implantation in STEMI was evidently higher than in the Western registries. In 1-year clinical outcomes, the incidence of stent thrombosis was low and mortality of AMI gradually improved and was lower than in the Western registries.

Effectiveness and safety of recombinant human brain natriuretic peptide in the treatment of acute myocardial infarction in elderly in combination with cardiac failure

Objective:

To investigate the effects and safety of recombinant human brain natriuretic peptide (rhBNP) in the treatment of elderly acute myocardial infarction induced cardiac failure.

Methods:

One hundred and forty-six patients who were diagnosed as elderly acute myocardial infarction induced cardiac failure in the hospital from July 2014 to July 2015 were selected. They were divided into a test group and a control group, 73 each. Patients in both groups were given conventional treatment such as stabilization of atherosclerotic plaques, anti-platelet and remodeling and reversion of myocardium. The curative effects and the incidence of adverse reactions of the two groups were observed.

Results:

The overall efficacy of the test group and the control group was 87.7% and 65.8% respectively, and the difference had statistical significance (P<0.05). The heart rate, urine volume, n-terminal pro-brain natriuretic peptide level and left ventricular ejection fraction (LVEF) of both groups significantly improved after treatment, and the improvement of the test group was superior to that of the control group (P<0.05). The serum creatinine of the test group remarkably reduced after treatment (P<0.05). The incidence of hypotension and arrhythmia of the test group was lower than that of the control group during hospitalization period (P<0.05).

Conclusion:

rhBNP can effectively relieve the clinical symptoms, cardiac function indexes and hemodynamic indexes of patients with elderly acute myocardial infarction induced cardiac failure, with a high safety. It can be extensively applied in the treatment of acute myocardial infarction in combination with cardiac failure.

Underuse of coronary intervention and its impact on mortality in the elderly with myocardial infarction. A propensity-matched analysis from the Hungarian Myocardial Infarction Registry

BACKGROUND

Data are limited on the real-life use of coronary intervention (PCI) and on its long-term efficacy and safety in elderly patients with acute myocardial infarction (AMI).

METHODS

Data from a nation-wide registry of patients treated due to an AMI event in centers of invasive cardiology were analyzed for the potential interaction of age on the utilization of invasive therapy and outcome. Follow-up data of consecutive patients between March 1, 2013, and March 1, 2014 were analyzed. Differences in the risk of all-cause death at 1year between patients undergoing PCI versus others receiving conservative treatment were determined from vital records and were compared with propensity score matching.

RESULTS

A total of 8485 consecutive patients were enrolled at 19 centers. Sixty-three percent of the patients were male; the mean age was 65.1±12.4years. The proportion of STEMI cases was 51%. STEMI cases were treated with primary PCI in 91.0% while patients with NSTEACS underwent PCI in 71.0%. The age of patients was a significant determinant of deferring coronary angiography (Hazard ratio (HR): 0.524 95% confidence interval (CI) 0.47-0.59, p<0.001) and PCI (HR: 0.76 95% CI 0.73-0.80, p<0.001). One-year survival after PCI was significantly better both in the overall and in the propensity matched cohort (HR: 0.44 [95% CI: 0.39-0.49] and HR: 0.59 [95% CI: 0.50-0.69], p<0.001, both). This benefit remained consistent in age-dependent subgroup analyses.

CONCLUSION

Coronary intervention is underused among the elderly despite the mortality benefit of interventional therapy in myocardial infarction that is consistent in all age groups.