Characteristics and Mortality Following Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction in Spain. Results From the TRIANA 1 (TRatamiento del Infarto Agudo de miocardio eN Ancianos) Registry

Although more elderly patients will experience acute myocardial infarction (AMI) in coming years, the best reperfusion strategy in these patients remains unknown. The Spanish TRIANA (TRatamiento del Infarto Agudo de miocardio eN Ancianos) registry was set up to determine the feasibility of performing a randomized study of percutaneous coronary intervention (PCI) versus thrombolysis in AMI patients aged ≥75 years. The TRIANA 1 subregistry included consecutive patients of all ages with ST-segment-elevation AMI (≤12 h from onset) who underwent PCI in selected hospitals. In total, 459 TRIANA-1 patients were included at 25 hospitals over 3 months. Some 11% had cardiogenic shock. PCI was performed as rescue therapy in 24% and, in 15% because thrombolysis was contraindicated. After PCI, 83% had TIMI grade-3 flow without significant residual stenosis. Mortality at 1 month was 10.8%. Independent predictors of mortality identified by multivariate analysis were: cardiogenic shock at admission (OR=7.2; 95% CI, 2.2–23.3), age (OR=1.05 per year; 95% CI, 1.005–1.100), maximum creatine kinase MB fraction (OR=1.01; 95% CI, 1.004–1.270), and post-PCI TIMI grade 75 years (mortality, 24%), 58 (55.7%) fulfilled criteria for inclusion in a randomized study. 1) The TRIANA 1 subregistry probably reflects the reality of PCI for AMI in Spain. 2) Mortality at 1 month was associated with classic predictive factors. 3) Some 50% of patients ≥75 years old who underwent PCI could be included in a randomized study. These findings indicate that randomized study to determine the best reperfusion strategy in elderly AMI patients is feasible. El número de pacientes de edad avanzada que presenta un infarto agudo de miocardio (IAM) se incrementará en los próximos años, sin que se conozca en la actualidad cuál es la mejor forma de reperfusión. El Registro TRIANA (TRatamiento del Infarto Agudo de miocardio eN Ancianos) se diseñó para analizar la factibilidad de efectuar un estudio aleatorizado en España para comparar la eficacia del intervencionismo coronario percutáneo (ICP) con la trombólisis en el tratamiento del IAM en pacientes de edad avanzada (≥ 75 años). El subregistro TRIANA 1 evaluó a todos los pacientes consecutivos, con independencia de la edad, en los que se efectuaba un procedimiento de ICP en IAM con ST elevado (≤ 12 h de evolución) en una serie de hospitales seleccionados. En el subregistro TRIANA 1 se incluyó a 459 pacientes