The Comparison of the Outcomes between Primary PCI, Fibrinolysis, and No Reperfusion in Patients ≥ 75 Years Old with ST-Segment Elevation Myocardial Infarction: Results from the Chinese Acute Myocardial Infarction (CAMI) Registry.

dc.contributor.author

Peiyuan, He

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Jingang, Yang

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Haiyan, Xu

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Xiaojin, Gao

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Ying, Xian

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Yuan, Wu

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Wei, Li

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Yang, Wang

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Xinran, Tang

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Ruohua, Yan

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Chen, Jin

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Lei, Song

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Xuan, Zhang

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Rui, Fu

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Yunqing, Ye

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Qiuting, Dong

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Hui, Sun

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Xinxin, Yan

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Runlin, Gao

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Yuejin, Yang

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CAMI Registry study group

dc.date.accessioned

2020-11-09T20:22:14Z

dc.date.available

2020-11-09T20:22:14Z

dc.date.issued

2016-01

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2020-11-09T20:22:13Z

dc.description.abstract

Only a few randomized trials have analyzed the clinical outcomes of elderly ST-segment elevation myocardial infarction (STEMI) patients (≥ 75 years old). Therefore, the best reperfusion strategy has not been well established. An observational study focused on clinical outcomes was performed in this population.Based on the national registry on STEMI patients, the in-hospital outcomes of elderly patients with different reperfusion strategies were compared. The primary endpoint was defined as death. Secondary endpoints included recurrent myocardial infarction, ischemia driven revascularization, myocardial infarction related complications, and major bleeding. Multivariable regression analysis was performed to adjust for the baseline disparities between the groups.Patients who had primary percutaneous coronary intervention (PCI) or fibrinolysis were relatively younger. They came to hospital earlier, and had lower risk of death compared with patients who had no reperfusion. The guideline recommended medications were more frequently used in patients with primary PCI during the hospitalization and at discharge. The rates of death were 7.7%, 15.0%, and 19.9% respectively, with primary PCI, fibrinolysis, and no reperfusion (P < 0.001). Patients having primary PCI also had lower rates of heart failure, mechanical complications, and cardiac arrest compared with fibrinolysis and no reperfusion (P < 0.05). The rates of hemorrhage stroke (0.3%, 0.6%, and 0.1%) and other major bleeding (3.0%, 5.0%, and 3.1%) were similar in the primary PCI, fibrinolysis, and no reperfusion group (P > 0.05). In the multivariable regression analysis, primary PCI outweighs no reperfusion in predicting the in-hospital death in patients ≥ 75 years old. However, fibrinolysis does not.Early reperfusion, especially primary PCI was safe and effective with absolute reduction of mortality compared with no reperfusion. However, certain randomized trials were encouraged to support the conclusion.

dc.identifier

PONE-D-16-28185

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1932-6203

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1932-6203

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https://hdl.handle.net/10161/21688

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eng

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Public Library of Science (PLoS)

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PloS one

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10.1371/journal.pone.0165672

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CAMI Registry study group

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Humans

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Heart Arrest

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Hemorrhage

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Fibrinolytic Agents

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Anticoagulants

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Treatment Outcome

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Thrombolytic Therapy

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Myocardial Reperfusion

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Registries

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Fibrinolysis

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Aged

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Aged, 80 and over

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China

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Female

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Male

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Heart Failure

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Percutaneous Coronary Intervention

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ST Elevation Myocardial Infarction

dc.title

The Comparison of the Outcomes between Primary PCI, Fibrinolysis, and No Reperfusion in Patients ≥ 75 Years Old with ST-Segment Elevation Myocardial Infarction: Results from the Chinese Acute Myocardial Infarction (CAMI) Registry.

dc.type

Journal article

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e0165672

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11

pubs.organisational-group

School of Medicine

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Duke Clinical Research Institute

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Neurology, Neurocritical Care

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Medicine, Clinical Pharmacology

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Duke

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Institutes and Centers

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Neurology

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Clinical Science Departments

pubs.organisational-group

Medicine

pubs.publication-status

Published

pubs.volume

11

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