In-hospital outcomes of emergent and elective percutaneous coronary intervention in octogenarians

Although the prevalence of coronary artery disease increases with age, elderly patients are underrepresented in clinical trials. We sought to describe the short-term outcomes of octogenarians undergoing percutaneous coronary intervention (PCI) in both emergent and elective settings.

We retrospectively identified all octogenarians undergoing PCI at our institution from January 2002 to December 2005. The outcomes of those undergoing primary PCI for ST-segment elevation myocardial infarction (group A) were compared with a randomly selected cohort of octogenarians undergoing elective PCI (group B).

Group A comprised 91 patients and group B 88 patients. Procedure success was high with Thrombolysis in Myocardial Infarction grade 3 flow achieved in greater than 90% of patients in both groups. Group A experienced more postprocedure morbidity including acute renal failure (47 vs. 8%) and bleeding requiring transfusion (51 vs. 17%) (P<0.0001 for both comparisons). In-hospital mortality was higher in group A (21 vs. 0%). In multivariate analysis, the risk of in-hospital mortality was predicted by lower admission systolic blood pressure (odds ratio 1.026 per point decrease in systolic blood pressure; 95% confidence interval 1.003-1.049; P = 0.030) and development of cardiogenic shock (odds ratio 7.506; 95% confidence interval, 1.865-30.207; P = 0.005). Mortality in group A was significantly higher among patients with cardiogenic shock (42 vs. 6%, P<0.001).

PCI is a safe and highly effective procedure in octogenarians during both emergent and elective settings. However, elderly patients undergoing primary angioplasty who develop hemodynamic instability during ST-segment elevation myocardial infarction remain at increased risk for mortality. Measures to reduce postprocedure bleeding and renal dysfunction may improve outcomes among elderly patients undergoing PCI.