List of Authors:
Héctor Bueno, Joaquín J. Alonso, Amadeo Betriu, Angel Cequier, Eulogio J. Garcia, Magda Heras, Jose L. Lopez-Sendon, Carlos Macaya, Rosana Hernandez-Antolin, on behalf of the TRIANA investigators, Spanish Society of Cardiology, Madrid, Spain
Abstract:
BACKGROUND:
Primary angioplasty (PCI) is currently considered the preferred reperfusion therapy for STEMI. However, data on clinical outcomes comparing primary PCI vs. fibrinolysis in very old patients are scarce.
METHODS:
The TRIANA study (clinicaltrials.gov # NCT00257309) is a Spanish multicenter randomized trial comparing primary PCI versus a conservative strategy consisting in fibrinolysis (weight-adjusted TNK+UFH) and rescue PCI. Included patients were 75 years of age or older presenting within 6 hours after STEMI. Patients with accepted contraindications for fibrinolysis and those with any previous cerebrovascular event, cardiogenic shock or blood pressure >180/110 mmHg at any time during the event were excluded. The primary endpoint was the composite of all-cause death, recurrent myocardial infarction, or disabling stroke at 30 days. Secondary endpoints were recurrent ischemia leading to revascularization, and major bleeding. Events were adjudicated by an “ad hoc” committee blinded to the study treatments.
RESULTS:
The trial was prematurely stopped due to slow recruitment, after enrolling 266 out of the 560 planned patients. Mean age was 81 years and 56% men. The two treatment groups were well balanced with regard to demographic characteristics and risk factors.
Outcomes at 30 days were as follows. After one-year follow-up, results tended to equate.
CONCLUSIONS:
In spite of the sample size limitation, this trial shows a trend towards a lower mortality, reinfarction and disabling stroke in elderly patients undergoing primary PCI compared with fibrinolysis. In addition, recurrent ischemia is dramatically reduced by primary PCI. Therefore, this approach might also be recommended for the oldest patients presenting with STEMI.
Notes to editor
This congress report accompanies a presentation given at the ESC Congress 2009. Written by the author himself/herself, this report does not necessarily reflect the opinion of the European Society of Cardiology.