Unprotected left main percutaneous coronary intervention in a 108-year-old patient
Afzalur Rahman1, Akm Monwarul Islam1
1Department of Cardiology, National Institute of Cardiovascular Diseases, Dhaka, Bangladesh.
Insights
Percutaneous coronary intervention (PCI) is feasible in centenarians with complex coronary artery disease (CAD). This case study details successful PCI in a centenarian, managing subsequent complications effectively.
Area of Science:
- Cardiology
- Interventional Cardiology
- Geriatric Medicine
Background:
- Increasing life expectancy leads to a growing population of very elderly individuals.
- Coronary artery disease (CAD) is a significant cause of mortality and morbidity in this demographic.
- Myocardial revascularization, including percutaneous coronary intervention (PCI), is often indicated for CAD in the elderly.
Purpose of the Study:
- To describe the outcome of percutaneous coronary intervention (PCI) in a centenarian patient with complex coronary artery disease (CAD).
- To highlight the safety, feasibility, and management of complications associated with PCI in extreme old age.
Main Methods:
- Case report of a centenarian patient presenting with unstable angina.
- Patient underwent percutaneous coronary intervention (PCI) due to ineligibility for surgical revascularization.
- Management of post-procedural non-cardiac complications using a multidisciplinary approach.
Main Results:
- Successful angiographic outcome following PCI in the centenarian patient.
- Development of non-cardiac complications post-PCI, which were successfully managed.
- Demonstrates the potential benefits of PCI in selected centenarian patients despite inherent risks.
Conclusions:
- Percutaneous coronary intervention (PCI) can be a viable option for centenarians with complex coronary artery disease (CAD) when surgery is not an option.
- Careful patient selection and a multidisciplinary approach are crucial for managing potential complications in this extreme age group.
- Further research is needed to establish definitive outcomes for PCI in centenarians, given the limited data.
Abstract:
With the increase in life expectancy, the proportion of very elderly people is increasing. Coronary artery disease (CAD) is an important cause of mortality and morbidity in this age group, for which myocardial revascularization is often indicated. Percutaneous coronary intervention (PCI) in the very elderly bears the inherent risks of complications and mortality, but the potential benefits may outweigh these risks. A number of observational studies, registries, and few randomized controlled trials have shown the safety and feasibility of PCI in octogenarians and nonagenarians. However, PCI is only rarely done in centenarians; so, the outcome of percutaneous coronary revascularization in this age group is largely unknown. PCI in a centenarian with complex CAD is described here; the patient presented with unstable angina despite optimum medical therapy, and surgery was declined. Good angiographic success was followed by non-cardiac complications, which were managed with a multidisciplinary approach.
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