Guideline-Directed Medical Therapy for Elderly Patients With Acute Myocardial Infarction Who Undergo Percutaneous Coronary Intervention　― Insights From a Retrospective Observational Study

• Published in: Circulation Journal 2024/05/24, Vol.88(6), pp.931-937
• Main Authors: Nishihira, Kensaku, Nakai, Michikazu, Kuriyama, Nehiro, Kadooka, Kosuke, Honda, Yasuhiro, Emori, Hiroki, Yamamoto, Keisuke, Nishino, Shun, Kudo, Takeaki, Ogata, Kenji, Kimura, Toshiyuki, Kaikita, Koichi, Shibata, Yoshisato
• Format: Article
• Language: English
• Subjects: Acute myocardial infarction; Adrenergic beta-Antagonists - therapeutic use; Age Factors; Aged, 80 and over; Angiotensin Receptor Antagonists - therapeutic use; Angiotensin-Converting Enzyme Inhibitors - therapeutic use; Elderly; Female; Guideline Adherence; Guideline-directed medical therapy; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; Male; Myocardial Infarction - mortality; Myocardial Infarction - therapy; Percutaneous Coronary Intervention; Practice Guidelines as Topic; Retrospective Studies; Treatment Outcome
• ISSN: 1346-9843; 1347-4820; 1347-4820
• DOI: 10.1253/circj.CJ-23-0837

Background: The efficacy of guideline-directed medical therapy (GDMT) in the elderly remains unclear. This study evaluated the impact of GDMT (aspirin or a P2Y12inhibitor, angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, β-blocker, and statin) at discharge on long-term mortality in elderly patients with acute myocardial infarction (AMI) who had undergone percutaneous coronary intervention (PCI).Methods and Results: Of 2,547 consecutive patients with AMI undergoing PCI in 2009–2020, we retrospectively analyzed 573 patients aged ≥80 years. The median follow-up period was 1,140 days. GDMT was prescribed to 192 (33.5%) patients at discharge. Compared with patients without GDMT, those with GDMT were younger and had higher rates of ST-segment elevation myocardial infarction and left anterior descending artery culprit lesion, higher peak creatine phosphokinase concentration, and lower left ventricular ejection fraction (LVEF). After adjusting for confounders, GDMT was independently associated with a lower cardiovascular death rate (hazard ratio [HR] 0.35; 95% confidence interval [CI] 0.16–0.81), but not with all-cause mortality (HR 0.77; 95% CI 0.50–1.18). In the subgroup analysis, the favorable impact of GDMT on cardiovascular death was significant in patients aged 80–89 years, with LVEF