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Elderly Patients with ST-Segment Elevation Myocardial Infarction: A Patient-Centered Approach

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Abstract

Large registries and epidemiologic studies have demonstrated that elderly patients (≥ 75 years old) represent a growing proportion of the acute coronary syndrome (ACS) population and are exposed to a high risk of both bleeding and ischemic events. In this setting, most of the randomized trials excluded elderly patients while evaluating therapeutic strategies in ACS and only few trials specifically dedicated their design to the elderly population, leading to a paucity of data. Elderly patients are less likely to be treated with an invasive strategy or potent antithrombotic drugs compared with younger patients, while they are exposed to a greater risk of mortality. Nevertheless, the benefit of an invasive approach in ST-segment elevation myocardial infarction (STEMI) has been consistently demonstrated in non-dedicated large percutaneous coronary intervention randomized trials, regardless of the patient’s age. European clinical practice guidelines recommend that STEMI in elderly patients should not be treated differently than in younger patients. However, the therapeutic decision should be based on a combined evaluation of both (1) the patient’s frailty, including functional or cognitive impairment, and (2) the balance between bleeding and ischemic risks. This review outlines the evidence on the optimal reperfusion and antithrombotic strategies among STEMI elderly patients, suggesting a patient-centered approach to apprehend the balanced therapeutic decision in the very old patient.

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Fig. 1

(adapted from Tarantini et al. meta-analysis [51]). The meta-analysis was performed from six studies with a total of 7394 elderly patients (3657 patients treated with potent P2Y12 inhibitors, 3737 patients treated with clopidogrel) for efficacy endpoints and five studies with a total of 7436 elderly patients (3497 patients treated with potent P2Y12 inhibitors, 3939 patients treated with clopidogrel) for safety endpoints. Potent P2Y12 inhibitors included ticagrelor, prasugrel 5 mg and prasugrel 10 mg. CI confidence interval, CV cardiovascular, MI myocardial infarction

Fig. 2

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References

  1. Lee PY, Alexander KP, Hammill BG, Pasquali SK, Peterson ED. Representation of elderly persons and women in published randomized trials of acute coronary syndromes. JAMA. 2001;286(6):708–13.

    Article  CAS  PubMed  Google Scholar 

  2. Alexander KP, Newby LK, Armstrong PW, et al. Acute coronary care in the elderly, part II: ST-segment-elevation myocardial infarction: a scientific statement for healthcare professionals from the American Heart Association Council on Clinical Cardiology: in collaboration with the Society of Geriatric Cardiology. Circulation. 2007;115(19):2570–89.

    Article  PubMed  Google Scholar 

  3. Hordijk-Trion M, Lenzen M, Wijns W, et al. Patients enrolled in coronary intervention trials are not representative of patients in clinical practice: results from the Euro Heart Survey on Coronary Revascularization. Eur Heart J. 2006;27(6):671–8.

    Article  PubMed  Google Scholar 

  4. Ibanez B, James S, Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the task force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018;39(2):119–77.

    Article  PubMed  Google Scholar 

  5. Toleva O, Ibrahim Q, Brass N, Sookram S, Welsh R. Treatment choices in elderly patients with ST: elevation myocardial infarction-insights from the Vital Heart Response registry. Open Heart. 2015;2(1):e000235. https://doi.org/10.1136/openhrt-2014-000235.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Avezum A, Makdisse M, Spencer F, et al. Impact of age on management and outcome of acute coronary syndrome: observations from the Global Registry of Acute Coronary Events (GRACE). Am Heart J. 2005;149(1):67–73.

    Article  PubMed  Google Scholar 

  7. Zaman MJ, Stirling S, Shepstone L, et al. The association between older age and receipt of care and outcomes in patients with acute coronary syndromes: a cohort study of the Myocardial Ischaemia National Audit Project (MINAP). Eur Heart J. 2014;35(23):1551–8.

    Article  PubMed  Google Scholar 

  8. Gharacholou SM, Alexander KP, Chen AY, et al. Implications and reasons for the lack of use of reperfusion therapy in patients with ST-segment elevation myocardial infarction: findings from the CRUSADE initiative. Am Heart J. 2010;159(5):757–63.

    Article  PubMed  Google Scholar 

  9. Assali AR, Moustapha A, Sdringola S, et al. The dilemma of success: percutaneous coronary interventions in patients > or = 75 years of age-successful but associated with higher vascular complications and cardiac mortality. Catheter Cardiovasc Interv. 2003;59(2):195–9.

    Article  PubMed  Google Scholar 

  10. Bagur R, Bertrand OF, Rodés-Cabau J, et al. Comparison of outcomes in patients > or = 70 years versus < 70 years after transradial coronary stenting with maximal antiplatelet therapy for acute coronary syndrome. Am J Cardiol. 2009;104(5):624–9.

    Article  PubMed  Google Scholar 

  11. Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol. 2001;56(3):M146–56.

    Article  CAS  Google Scholar 

  12. Afilalo J, Alexander KP, Mack MJ, et al. Frailty assessment in the cardiovascular care of older adults. J Am Coll Cardiol. 2014;63(8):747–62.

    Article  PubMed  Google Scholar 

  13. Jomaa W, Hamdi S, Ben Ali I, et al. Risk profile and in-hospital prognosis in elderly patients presenting for acute ST-elevation myocardial infarction in the Tunisian context. Indian Heart J. 2016;68(6):760–5.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Alexander KP, Chen AY, Roe MT, et al. Excess dosing of antiplatelet and antithrombin agents in the treatment of non-ST-segment elevation acute coronary syndromes. JAMA. 2005;294(24):3108–16.

    Article  CAS  PubMed  Google Scholar 

  15. Mehran R, Pocock SJ, Nikolsky E, et al. A risk score to predict bleeding in patients with acute coronary syndromes. J Am Coll Cardiol. 2010;55(23):2556–66.

    Article  PubMed  Google Scholar 

  16. Silvain J, Nguyen LS, Spagnoli V, et al. Contrast-induced acute kidney injury and mortality in ST elevation myocardial infarction treated with primary percutaneous coronary intervention. Heart. 2018;104(9):767–72.

    Article  CAS  PubMed  Google Scholar 

  17. Malkin CJ, Prakash R, Chew DP. The impact of increased age on outcome from a strategy of early invasive management and revascularisation in patients with acute coronary syndromes: retrospective analysis study from the ACACIA registry. BMJ Open. 2012;2(1):e000540. https://doi.org/10.1136/bmjopen-2011-000540.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Mehta RH, Sadiq I, Goldberg RJ, et al. Effectiveness of primary percutaneous coronary intervention compared with that of thrombolytic therapy in elderly patients with acute myocardial infarction. Am Heart J. 2004;147(2):253–9.

    Article  PubMed  Google Scholar 

  19. Helft G, Georges J-L, Mouranche X, et al. Outcomes of primary percutaneous coronary interventions in nonagenarians with acute myocardial infarction. Int J Cardiol. 2015;192:24–9.

    Article  PubMed  Google Scholar 

  20. de Boer SPM, Westerhout CM, Simes RJ, et al. Mortality and morbidity reduction by primary percutaneous coronary intervention is independent of the patient’s age. JACC Cardiovasc Interv. 2010;3(3):324–31.

    Article  PubMed  Google Scholar 

  21. Khera S, Kolte D, Palaniswamy C, et al. ST-elevation myocardial infarction in the elderly—temporal trends in incidence, utilization of percutaneous coronary intervention and outcomes in the United States. Int J Cardiol. 2013;168(4):3683–90.

    Article  PubMed  Google Scholar 

  22. Mandawat A, Mandawat A, Mandawat MK. Percutaneous coronary intervention after ST-segment elevation myocardial infarction in nonagenarians: use rates and in-hospital mortality. J Am Coll Cardiol. 2013;61(11):1207–8.

    Article  PubMed  Google Scholar 

  23. Yudi MB, Jones N, Fernando D, et al. Management of patients aged ≥ 85 years with ST-elevation myocardial infarction. Am J Cardiol. 2016;118(1):44–8.

    Article  PubMed  Google Scholar 

  24. Devlin G, Gore JM, Elliott J, et al. Management and 6-month outcomes in elderly and very elderly patients with high-risk non-ST-elevation acute coronary syndromes: the Global Registry of Acute Coronary Events. Eur Heart J. 2008;29(10):1275–82.

    Article  PubMed  Google Scholar 

  25. Skolnick AH, Alexander KP, Chen AY, et al. Characteristics, management, and outcomes of 5,557 patients age > or = 90 years with acute coronary syndromes: results from the CRUSADE initiative. J Am Coll Cardiol. 2007;49(17):1790–7.

    Article  PubMed  Google Scholar 

  26. Armstrong PW, Gershlick AH, Goldstein P, et al. Fibrinolysis or primary PCI in ST-segment elevation myocardial infarction. N Engl J Med. 2013;368(15):1379–87.

    Article  CAS  PubMed  Google Scholar 

  27. Bonnefoy E, Lapostolle F, Leizorovicz A, et al. Primary angioplasty versus prehospital fibrinolysis in acute myocardial infarction: a randomised study. Lancet. 2002;360(9336):825–9.

    Article  PubMed  Google Scholar 

  28. Peiyuan H, Jingang Y, Haiyan X, et al. 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. PLoS ONE. 2016;11(11):e0165672. https://doi.org/10.1371/journal.pone.0165672.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Thiemann DR, Coresh J, Schulman SP, Gerstenblith G, Oetgen WJ, Powe NR. Lack of benefit for intravenous thrombolysis in patients with myocardial infarction who are older than 75 years. Circulation. 2000;101(19):2239–46.

    Article  CAS  PubMed  Google Scholar 

  30. Mehta RH, Granger CB, Alexander KP, Bossone E, White HD, Sketch MH. Reperfusion strategies for acute myocardial infarction in the elderly: benefits and risks. J Am Coll Cardiol. 2005;45(4):471–8.

    Article  PubMed  Google Scholar 

  31. Berger AK, Schulman KA, Gersh BJ, et al. Primary coronary angioplasty vs thrombolysis for the management of acute myocardial infarction in elderly patients. JAMA. 1999;282(4):341–8.

    Article  CAS  PubMed  Google Scholar 

  32. de Boer M-J, Ottervanger J-P, van ’t Hof AWJ, et al. Reperfusion therapy in elderly patients with acute myocardial infarction: a randomized comparison of primary angioplasty and thrombolytic therapy. J Am Coll Cardiol. 2002;39(11):1723–8.

    Article  PubMed  Google Scholar 

  33. Bueno H, Betriu A, Heras M, et al. Primary angioplasty vs. fibrinolysis in very old patients with acute myocardial infarction: TRIANA (TRatamiento del Infarto Agudo de miocardio eN Ancianos) randomized trial and pooled analysis with previous studies. Eur Heart J. 2011;32(1):51.

    Article  PubMed  Google Scholar 

  34. Tisminetzky M, Erskine N, Chen H-Y, et al. Changing trends in, and characteristics associated with, not undergoing cardiac catheterization in elderly adults hospitalized with ST-segment elevation acute myocardial infarction. J Am Geriatr Soc. 2015;63(5):925–31.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Johnman C, Oldroyd KG, Mackay DF, et al. Percutaneous coronary intervention in the elderly: changes in case-mix and periprocedural outcomes in 31,758 patients treated between 2000 and 2007. Circ Cardiovasc Interv. 2010;3(4):341–5.

    Article  PubMed  Google Scholar 

  36. Fox KAA, Steg PG, Eagle KA, et al. Decline in rates of death and heart failure in acute coronary syndromes, 1999–2006. JAMA. 2007;297(17):1892–900.

    Article  CAS  PubMed  Google Scholar 

  37. Rodriguez-Leor O, Fernandez-Nofrerias E, Carrillo X, et al. Results of primary percutaneous coronary intervention in patients ≥ 75 years treated by the transradial approach. Am J Cardiol. 2014;113(3):452–6.

    Article  PubMed  Google Scholar 

  38. Varenne O, Cook S, Sideris G, et al. Drug-eluting stents in elderly patients with coronary artery disease (SENIOR): a randomised single-blind trial. Lancet. 2018;391(10115):41–50.

    Article  CAS  PubMed  Google Scholar 

  39. Van De Werf F, Adgey J, Ardissino D, et al. Single-bolus tenecteplase compared with front-loaded alteplase in acute myocardial infarction: the ASSENT-2 double-blind randomised trial. Lancet. 1999;354(9180):716–22.

    Article  Google Scholar 

  40. Armstrong PW, Zheng Y, Westerhout CM, et al. Reduced dose tenecteplase and outcomes in elderly ST-segment elevation myocardial infarction patients: insights from the STrategic Reperfusion Early After Myocardial infarction trial. Am Heart J. 2015;169(6):890.e1–898.e1.

    Article  CAS  Google Scholar 

  41. Bellemain-Appaix A, Bégué C, Bhatt DL, et al. The efficacy of early versus delayed P2Y12 inhibition in percutaneous coronary intervention for ST-elevation myocardial infarction: a systematic review and meta-analysis. EuroIntervention. 2018;14(1):78–85.

    Article  PubMed  Google Scholar 

  42. Wiviott SD, Braunwald E, McCabe CH, et al. Prasugrel versus clopidogrel in patients with acute coronary syndromes. N Engl J Med. 2007;357(20):2001–15.

    Article  CAS  PubMed  Google Scholar 

  43. Wallentin L, Becker RC, Budaj A, et al. Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med. 2009;361(11):1045–57.

    Article  CAS  PubMed  Google Scholar 

  44. Danchin N, Lettino M, Zeymer U, et al. Use, patient selection and outcomes of P2Y12 receptor inhibitor treatment in patients with STEMI based on contemporary European registries. Eur Heart J Cardiovasc Pharmacother. 2016;2(3):152–67.

    Article  PubMed  Google Scholar 

  45. Husted S, James S, Becker RC, et al. Ticagrelor versus clopidogrel in elderly patients with acute coronary syndromes: a substudy from the prospective randomized PLATelet inhibition and patient Outcomes (PLATO) trial. Circ Cardiovasc Qual Outcomes. 2012;5(5):680–8.

    Article  PubMed  Google Scholar 

  46. Collet J-P, Kerneis M, Lattuca B, et al. The effect of prehospital P2Y12 receptor inhibition in primary percutaneous coronary intervention for ST-segment elevation myocardial infarction: the ATLANTIC-Elderly analysis. EuroIntervention. 2018;14(7):789–97.

    Article  PubMed  Google Scholar 

  47. Montalescot G, van ’t Hof AW, Lapostolle F, et al. Prehospital ticagrelor in ST-segment elevation myocardial infarction. N Engl J Med. 2014;371(11):1016–27.

    Article  CAS  PubMed  Google Scholar 

  48. Wiviott SD, Desai N, Murphy SA, et al. Efficacy and safety of intensive antiplatelet therapy with prasugrel from TRITON-TIMI 38 in a core clinical cohort defined by worldwide regulatory agencies. Am J Cardiol. 2011;108(7):905–11.

    Article  CAS  PubMed  Google Scholar 

  49. Roe MT, Armstrong PW, Fox KAA, et al. Prasugrel versus clopidogrel for acute coronary syndromes without revascularization. N Engl J Med. 2012;367(14):1297–309.

    Article  CAS  PubMed  Google Scholar 

  50. Savonitto S, Ferri LA, Piatti L, et al. A comparison of reduced-dose prasugrel and standard-dose clopidogrel in elderly patients with acute coronary syndromes undergoing early percutaneous revascularization. Circulation. 2018;137(23):2435–45.

    Article  CAS  PubMed  Google Scholar 

  51. Tarantini G, Ueshima D, D’Amico G, et al. Efficacy and safety of potent platelet P2Y12 receptor inhibitors in elderly versus nonelderly patients with acute coronary syndrome: a systematic review and meta-analysis. Am Heart J. 2018;195:78–85.

    Article  CAS  PubMed  Google Scholar 

  52. Agewall S, Cattaneo M, Collet JP, et al. Expert position paper on the use of proton pump inhibitors in patients with cardiovascular disease and antithrombotic therapy. Eur Heart J. 2013;34(23):1708–13 (1713a–1713b).

    Article  PubMed  Google Scholar 

  53. Bhatt DL, Stone GW, Mahaffey KW, et al. Effect of platelet inhibition with cangrelor during PCI on ischemic events. N Engl J Med. 2013;368(14):1303–13.

    Article  CAS  PubMed  Google Scholar 

  54. Cavender MA, Bhatt DL, Stone GW, et al. Cangrelor in older patients undergoing percutaneous coronary intervention: findings from CHAMPION PHOENIX. Circ Cardiovasc Interv. 2017;10(8):e005257.

    Article  CAS  PubMed  Google Scholar 

  55. Silvain J, Cayla G, Hulot J-S, et al. High on-thienopyridine platelet reactivity in elderly coronary patients: the SENIOR-PLATELET study. Eur Heart J. 2012;33(10):1241–9.

    Article  CAS  PubMed  Google Scholar 

  56. Cuisset T, Cayla G, Frere C, et al. Predictive value of post-treatment platelet reactivity for occurrence of post-discharge bleeding after non-ST elevation acute coronary syndrome. Shifting from antiplatelet resistance to bleeding risk assessment? EuroIntervention. 2009;5(3):325–9.

    Article  PubMed  Google Scholar 

  57. Cayla G, Cuisset T, Silvain J, et al. Platelet function monitoring to adjust antiplatelet therapy in elderly patients stented for an acute coronary syndrome (ANTARCTIC): an open-label, blinded-endpoint, randomised controlled superiority trial. Lancet. 2016;388(10055):2015–22.

    Article  CAS  PubMed  Google Scholar 

  58. Sibbing D, Aradi D, Jacobshagen C, et al. Guided de-escalation of antiplatelet treatment in patients with acute coronary syndrome undergoing percutaneous coronary intervention (TROPICAL-ACS): a randomised, open-label, multicentre trial. Lancet. 2017;390(10104):1747–57.

    Article  CAS  PubMed  Google Scholar 

  59. Sibbing D, Gross L, Trenk D, et al. Age and outcomes following guided de-escalation of antiplatelet treatment in acute coronary syndrome patients undergoing percutaneous coronary intervention: results from the randomized TROPICAL-ACS trial. Eur Heart J. 2018;39(29):2749–58.

    Article  CAS  PubMed  Google Scholar 

  60. Valgimigli M, Bueno H, Byrne RA, et al. 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS: the task force for dual antiplatelet therapy in coronary artery disease of the European Society of Cardiology (ESC) and of the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2018;39(3):213–60.

    Article  PubMed  Google Scholar 

  61. Eindhoven DC, Hilt AD, Zwaan TC, Schalij MJ, Borleffs CJW. Age and gender differences in medical adherence after myocardial infarction: women do not receive optimal treatment—the Netherlands claims database. Eur J Prev Cardiol. 2018;25(2):181–9.

    Article  PubMed  Google Scholar 

  62. Melberg T, Jørgensen M, Ørn S, Solli T, Edland U, Dickstein K. Safety and health status following early discharge in patients with acute myocardial infarction treated with primary PCI: a randomized trial. Eur J Prev Cardiol. 2015;22(11):1427–34.

    Article  PubMed  Google Scholar 

  63. Azzalini L, Solé E, Sans J, et al. Feasibility and safety of an early discharge strategy after low-risk acute myocardial infarction treated with primary percutaneous coronary intervention: the EDAMI pilot trial. Cardiology. 2015;130(2):120–9.

    Article  PubMed  Google Scholar 

  64. Andreotti F, Rocca B, Husted S, et al. Antithrombotic therapy in the elderly: expert position paper of the European Society of Cardiology Working Group on Thrombosis. Eur Heart J. 2015;36(46):3238–49.

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Sorbonne Université, ACTION Study Group, INSERM UMR_S 1166, Institut de Cardiologie, Pitié-Salpêtrière Hospital (AP-HP), Paris, France

    Benoit Lattuca, Mathieu Kerneis, Michel Zeitouni, Paul Guedeney, Jean-Philippe Collet, Gilles Montalescot & Johanne Silvain

  2. ACTION Study Group, Cardiology Department, Nîmes University Hospital, Montpellier University, Nîmes, France

    Benoit Lattuca & Guillaume Cayla

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  1. Benoit Lattuca
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  2. Mathieu Kerneis
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Correspondence to Johanne Silvain.

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Conflict of interest

B. Lattuca has received research grants from Biotronik, Daiichi-Sankyo and Fédération Française de Cardiologie; consultant fees from Daiichi-Sankyo and Eli Lilly; and lecture fees from AstraZeneca and Novartis. M. Kerneis has received research grants from Sanofi, Institut Servier and Fédération Française de Cardiologie; consultant fees from Bayer and AstraZeneca. M. Zeitouni has received research grants from Institut Servier and Federation Française de Cardiologie. G. Cayla has received consulting and lecture fees from Abbott Vascular, AstraZeneca, Bayer, BMS, Boehringer-Ingelheim, Boston Scientific, CLS Behring, Daiichi-Sankyo, Eli Lilly, Iroko Cardio, Novartis and Pfizer. P. Guedeney reports no financial relationships or conflicts of interest. J.P. Collet has received research grants or honorarium from AstraZeneca, Bayer, Bristol-Myers Squibb, Daiichi-Sankyo, Eli-Lilly, Fédération Française de Cardiologie, Lead-Up, Medtronic, MSD, Sanofi-Aventis, and WebMD. G. Montalescot has received research grants or honorarium from Abbott, Amgen, Actelion, AstraZeneca, Bayer, Boehringer-Ingelheim, Boston-Scientific, Bristol-Myers Squibb, Beth Israel Deaconess Medical, Brigham Women’s Hospital, Cardiovascular Research Foundation, Daiichi-Sankyo, Idorsia, Lilly, Europa, Elsevier, Fédération Française de Cardiologie, ICAN, Medtronic, Journal of the American College of Cardiology, Lead-Up, Menarini, MSD, Novo-Nordisk, Pfizer, Sanofi, Servier, the Mount Sinai School, TIMI Study Group, and WebMD. J. Silvain has received consulting fees from AstraZeneca, Bayer, Boehringer-Ingelheim, Gilead Science and Sanofi-Aventis; speaker honorariums from AstraZeneca, Amgen, Bayer, Algorythm and Sanofi-Aventis; and travel support from Amgen, AstraZeneca, Bayer and Bristol-Myer Squibb.

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Lattuca, B., Kerneis, M., Zeitouni, M. et al. Elderly Patients with ST-Segment Elevation Myocardial Infarction: A Patient-Centered Approach. Drugs Aging 36, 531–539 (2019). https://doi.org/10.1007/s40266-019-00663-y

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