Primary percutaneous coronary interventions in nonagenarians
Michael Koutouzis1, Lars Grip, Göran Matejka
1Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden. michail.koutouzis@vgregion.se
Clinical Cardiology
|March 18, 2010
Summary
Primary percutaneous coronary intervention (PCI) is feasible for nonagenarians with ST elevation myocardial infarction (STEMI). However, short-term mortality remains high, particularly for those with anterior infarcts or impaired heart function.
Area of Science:
- Cardiology
- Geriatric Medicine
- Interventional Cardiology
Background:
- Optimal treatment for very elderly patients with ST elevation myocardial infarction (STEMI) is undefined.
- This study assesses the feasibility and safety of primary percutaneous coronary intervention (PCI) in nonagenarians.
Purpose of the Study:
- To evaluate the feasibility and safety of primary PCI in patients aged 90 years and older with STEMI.
- To identify factors influencing outcomes in this specific patient group.
Main Methods:
- Retrospective analysis of STEMI patients undergoing primary PCI between 2004 and 2008.
- Inclusion criteria: patients aged 90 years or older at the time of the procedure.
Main Results:
- Eighty-two percent procedural success rate in 22 nonagenarian patients (median age 92).
- Procedural mortality was 9%; in-hospital and 30-day mortality were 27% and 32%, respectively.
- Higher mortality observed in patients with Killip class III-IV and anterior infarct location.
Conclusions:
- Primary PCI is a feasible revascularization strategy for STEMI in nonagenarians.
- High short-term mortality necessitates careful consideration, especially in patients with anterior STEMI or severe left ventricular dysfunction.
Related Concept Videos
01:27Peripheral Artery Disease III: Interprofessional Care
Peripheral Artery Disease (PAD) is characterized by narrowed arteries that diminish blood flow to the extremities. Effective management of PAD requires an interprofessional approach involving various healthcare professionals. The critical aspects of interprofessional care for PAD patients focus on risk factor modification, drug therapy, exercise therapy, nutrition therapy, critical limb ischemia care, and interventional radiology and surgical procedures.The primary treatment goal for PAD...
01:27Pharmacodynamics in Geriatric Patients: Effects of Age
Age-related pharmacokinetic changes are extensively documented, but understanding age-related pharmacodynamic alterations is relatively limited. This knowledge gap can be partly attributed to the complexity of developing appropriate measures of drug responses compared to bioanalytical methods for determining drug concentrations.Most information regarding age-related differences in human pharmacodynamics originates from cross-sectional studies. However, these studies assume that observed mean...
01:27Coronary Artery Disease V: Interprofessional Care
Interprofessional care for coronary artery disease includes pharmacological therapy and revascularization procedures.Pharmacological therapy for Coronary Artery Disease (CAD) aims to manage symptoms, prevent complications, and improve patient outcomes through various classes of medications:Antiplatelet Agents:Aspirin and Clopidogrel: These medications inhibit platelet aggregation, preventing blood clots, which is crucial for avoiding heart attacks and strokes. Doctors often prescribe these...
01:28Acute Coronary Syndrome IV: Interprofessional Care
IntroductionThe management of Acute Coronary Syndrome (ACS) aims to minimize myocardial damage, preserve myocardial function, and prevent complications.Initial ManagementInpatient management involves continuous cardiac monitoring, preferably in an ICU, focusing on blood pressure, serum sodium, potassium, and creatinine levels, and urine output. Ongoing pharmacologic management is crucial for stabilizing the patient.Supplemental Oxygen: Administer supplemental oxygen if oxygen saturation is...
01:28Cardiac Catheterization I: Pre-Procedure Overview
Cardiac catheterization is an invasive diagnostic technique used to identify and evaluate structural and functional diseases of the heart and major blood vessels. This technique diagnoses congenital heart disease, coronary artery disease, valvular heart disease, and coronary spasms and assesses ventricular function. It helps guide treatment decisions, including the need for revascularization procedures like percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) and...
01:26Coronary Artery Disease IV: Preventive Measures
Effective preventive measures for coronary artery disease (CAD) focus on controlling modifiable risk factors, including cholesterol abnormalities and lifestyle changes.Cholesterol ManagementFirst, the Mediterranean diet and the American Heart Association advocate for maintaining low-density lipoprotein (LDL) cholesterol levels below 100 mg/dL, with a more stringent recommendation of below 70 mg/dL for individuals at high risk. LDL cholesterol, often termed "bad cholesterol," can lead to the...