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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EPrimary percutaneous coronary intervention was not found to provide an advantage over fibrinolytic therapy for very elderly patients with acute myocardial infarction, according to findings from the Tratamiento del Infarto Agudo de Miocardio en Ancianos [TRIANA; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00257309\u0026amp;atom=%2Fspmdc%2F9%2F4%2F13.2.atom\u0022\u003ENCT00257309\u003C\/a\u003E] trial, which was halted early due to slow enrollment. Although TRIANA failed to meet its primary endpoint, it did show favorable (albeit nonsignificant) trends with an invasive strategy in this relatively unstudied group with a relatively small sample size.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EMyocardial Infarction\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices Clinical Trials\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EPrimary percutaneous coronary intervention (PCI) was not found to provide an advantage over fibrinolytic therapy for very elderly patients with acute myocardial infarction (AMI), according to findings from the Tratamiento del Infarto Agudo de Miocardio en Ancianos (TRIANA) trial (\u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00257309\u0026amp;atom=%2Fspmdc%2F9%2F4%2F13.2.atom\u0022\u003ENCT00257309\u003C\/a\u003E), which was halted early due to slow enrollment. Although TRIANA failed to meet its primary endpoint, it did show favorable (albeit nonsignificant) trends with an invasive strategy in this relatively unstudied group with a relatively small sample size.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EPCI is the preferred therapy for ST-segment elevation MI (STEMI); yet the majority of very elderly patients (aged \u226575 years) with STEMI is treated with fibrinolytic therapy or no reperfusion therapy. Many physicians may be reluctant to use any reperfusion strategy in the elderly, given the sparse evidence that supports primary PCI and the fear of increased bleeding risk with fibrinolytic therapy in very elderly patients, said Professor H\u00e9ctor Bueno, MD, PhD, Hospital General Universitario Gregorio Mara\u00f1\u00f3n, Madrid, Spain. Dr. Bueno presented results of the TRIANA trial, which was designed to compare the efficacy and safety of primary PCI and fibrinolytic therapy in patients aged \u226575 years.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003ETRIANA included patients aged \u226575 years (mean age, 81 years) who presented within 6 hours of symptom onset with STEMI and without contraindications for fibrinolysis at centers that offered primary angioplasty in Spain. Patients were randomly assigned to fibrinolytic therapy that consisted of weight-adjusted tenecteplase, unfractionated heparin, and clopidogrel (n=134) or primary angioplasty with clopidogrel and, at the physician\u0027s discretion, abciximab (n=132). The primary endpoint was the cumulative incidence of all-cause death, reinfarction, or disabling stroke at 30 days. Initially, the study was powered to detect a 40% relative risk reduction in the primary endpoint, based on a sample size of 560 patients. However, TRIANA was discontinued early due to slow recruitment after enrolling only 266 patients.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EAt 30 days, there were numerically fewer (but statistically not significant) primary endpoint events in the primary PCI group (18.9%) than in the fibrinolytic therapy group (25.4%; OR, 1.46; p=0.21). Each component of the primary endpoint tended to occur less frequently with PCI, including death (13.6% vs 17.2%; p=0.43), reinfarction (5.3% vs 8.2%; p=0.35), and disabling stroke (0.8% vs 3.0%; p=0.18). At 12 months, results for the primary endpoint again showed no statistically significant difference between treatment groups (27.3% vs 32.1%; p=0.31)\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EAmong secondary outcomes, primary PCI significantly reduced the risk of recurrent ischemia compared with fibrinolysis (0.8% vs 9.7%; p\u0026lt;0.001). No differences were found between the primary PCI and fibrinolytic therapy groups in a range of safety outcomes, including major bleeding (3.8% vs 4.5%; p=0.78), need for transfusion (5.3% vs 3.0%; p=0.35), and renal failure (6.1% vs 7.5%; p=0.64).\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EAlthough TRIANA lacked the statistical power to demonstrate the superiority of PCI over fibrinolytic therapy, the observed risk reduction was consistent with the benefit that had been anticipated with primary PCI in the initial design of the study. Primary angioplasty should be considered the treatment of choice even in very old patients with STEMI. In situations in which primary PCI is not available, safety findings from TRIANA indicate that fibrinolysis may be considered as an alternative, with an acceptable rate of intracerebral hemorrhage among old patients who are carefully selected for fibrinolytic therapy.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2009 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/9\/4\/13.2.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzmisp\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}