Temporal trends and improved outcomes of percutaneous coronary revascularization in nonagenarians
Aaron M From1, Charanjit S Rihal, Ryan J Lennon
1Department of Internal Medicine, Division of Cardiovascular Diseases, Mayo Clinic College of Medicine and Mayo Foundation, Rochester, Minnesota, USA.
Insights
Percutaneous coronary intervention (PCI) in nonagenarians shows high technical success and improved in-hospital mortality over time. Advanced age should not preclude PCI when indicated.
Area of Science:
- Cardiology
- Geriatric Medicine
- Interventional Cardiology
Background:
- Limited data exists on outcomes for nonagenarians undergoing percutaneous coronary intervention (PCI).
- Understanding PCI outcomes in this elderly population is crucial for treatment decisions.
Purpose of the Study:
- To describe clinical characteristics and outcomes of patients aged 90 years and older treated with PCI.
- To evaluate trends in PCI outcomes for nonagenarians over time.
Main Methods:
- Retrospective analysis of 138 nonagenarians from the Mayo Clinic PCI registry over 19 years.
- Comparison of outcomes between patients treated before and after the year 2000.
Main Results:
- High technical success rate (91%) for PCI in nonagenarians.
- In-hospital mortality significantly decreased from 22% pre-2000 to 6% in 2000-2006.
- Long-term survival was comparable to an age-matched cohort.
Conclusions:
- PCI can be performed with high technical success and acceptable morbidity/mortality in carefully selected nonagenarians.
- Advanced age alone should not be a contraindication for coronary angiography and PCI when indicated.
Objectives:
The aim of this study was to describe the clinical characteristics and the outcomes of patients 90 years of age or older who were treated with percutaneous coronary intervention (PCI).
Background:
There is a paucity of outcomes data among nonagenarians undergoing PCI.
Methods:
We evaluated the outcomes of all patients 90 years of age or older in the Mayo Clinic PCI registry and examined trends over time.
Results:
Over a period of 19 years, we identified 138 nonagenarians (66% women; age 92.2 +/- 2.0 years). Mean duration of hospitalization was 3.7 +/- 3.1 days, and the median follow-up duration was 3.6 years. Ninety-one percent of patients presented with an acute coronary syndrome and underwent urgent or emergent revascularization. Technical success rate was 91%. Overall, the frequency of in-hospital death, Q-wave myocardial infarction, and major adverse cardiac events (composite of death, Q-wave myocardial infarction, urgent or emergent coronary artery bypass grafting, and cerebrovascular accident) were 9.4%, 0.7%, and 12.3%, respectively. The long-term survival of the cohort was not significantly different than that of an age, gender, and calendar year of birth-matched Minnesota cohort. The cohort was divided into 2 groups according to the time of their intervention: pre-2000 (n = 32) and 2000 to 2006 (n = 106). The in-hospital mortality decreased markedly: 22% to 6% (p = 0.006), respectively.
Conclusions:
Our study demonstrates that, in carefully selected patients, PCI in contemporary practice may be performed with high technical success with relatively low mortality and morbidity. Thus, advanced age alone must not be considered a contraindication to performing coronary angiography and PCI when clear indications are present.
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