Primary percutaneous coronary interventions in nonagenarians
Michael Koutouzis1, Lars Grip, Göran Matejka
1Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden. michail.koutouzis@vgregion.se
Insights
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.
Background:
The optimal treatment of very elderly patients with ST elevation myocardial infarction (STEMI) is not yet defined. The aim of this study is to present the feasibility and safety of primary percutaneous coronary interventions (PCI) in nonagenarians.
Methods:
A retrospective analysis of all patients who underwent primary PCI due to STEMI between 2004 and 2008 was performed. Patients age 90 years or older at the time of the procedure were identified and studied.
Results:
Twenty-two patients fulfilled the study criteria (median age 92 years; range, 90-97 years; 50% women). The procedural success rate was 82%. Bare metal stent implantation was performed in 82% of the procedures, whereas only balloon angioplasty was performed on the rest of them. One patient experienced a minor bleeding complication. Procedural mortality was 9% (2 out of 22 patients), and it was due to "no flow" phenomenon in both patients. In-hospital mortality was 27% (6/22 patients) and 30-day mortality was 32% (7/22 patients). All 3 patients with Killip class III-IV on admission died within 30 days compared with 4 of the 19 patients with Killip class I-II (P = 0.023). Furthermore, of 11 patients with anterior infarction, 7 died within 30 days compared with none of the 11 patients with infarction of other location (P = 0.004).
Conclusions:
Although primary PCI is feasible in patients 90 years or older suffering from STEMI, the short-term mortality rate is high especially in patients with anterior infarct location and/or severely depressed myocardial function.
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