Is percutaneous coronary intervention effective in in patients with other conditions?

This study investigated the effect of percutaneous coronary intervention (PCI) on in-hospital mortality of patients who have had heart attacks. The effects of age, sex, type of heart attack, diabetes, and chronic kidney disease (CKD) were examined. It was determined that PCI reduced mortality in all groups.

PCI is an urgent non-surgical procedure that is used to treat people having heart attacks. A heart attack, or myocardial infarction, occurs when the arteries supplying blood to the heart (coronary arteries) become narrowed or blocked. In PCI these arteries are widened or unblocked.

There are two main types of heart attack; STEMI and non-STEMI (NSTEMI). In STEMI there is a more severe block of a coronary artery that needs immediate treatment.

PCI reduces the risk of death in most patients with heart attacks. However, the effect on older patients with other conditions, such as diabetes or CKD, is unclear.

Information about 79,791 adults who were admitted to hospital following a heart attack was gathered from a European database. The effect of PCI on in-hospital mortality, by age group, sex, type of heart attack, and whether the patients had diabetes or CKD, was analyzed.

Patients older than 75 were more likely to have diabetes and/or chronic kidney disease, and to have had a previous heart attack. They were also more likely to have a NSTEMI than a STEMI. In general, male patients were more likely to survive than female patients, and patients with NSTEMIs were more likely to survive than patients with STEMIs. All patients with STEMI, and patients younger than 75 with NSTEMI, were less likely to survive if they had diabetes. All patients were less likely to survive if they had CKD.

PCI increased the likelihood of surviving in all patients with heart attacks, regardless of age, sex, and heart attack type. This effect was larger in men than in women older than 75. Women older than 75 were 54% more likely to survive after PCI, compared to 70% in men older than 75. The effect was also larger for patients younger than 75 with NSTEMIs, compared to those with STEMIs. Patients younger than 75 with STEMIs were 60% more likely to survive after PCI, compared to 78% of those with NSTEMIs. PCI increased the likelihood of surviving in patients with and without diabetes and CKD.

The study concluded that PCI reduced mortality in all groups, particularly in men older than 75, and patients younger than 75 with NSTEMIs

The database did not include all relevant information. Information on the type of PCI used, and other medications taken by patients, was not included. This information could have affected the results of the study.