Outcomes of primary percutaneous coronary interventions in nonagenarians with acute myocardial infarction
Gérard Helft1, Jean-Louis Georges2, Xavier Mouranche3
1Assistance Publique-Hôpitaux de Paris, Cardiology Department, Pitié-Salpétrière Hospital, Paris, France; Assistance Publique-Hôpitaux de Paris, ICAN, Pitié-Salpétrière Hospital, Paris, France; Pierre et Marie-Curie University, Paris, France.
Insights
Primary percutaneous coronary intervention (pPCI) for STEMI in nonagenarians shows higher in-hospital mortality despite similar reperfusion rates compared to younger patients. This study highlights demographic differences and outcomes in this elderly population.
Area of Science:
- Cardiology
- Interventional Cardiology
- Geriatric Cardiology
Background:
- Limited data exists on primary percutaneous coronary intervention (pPCI) outcomes in nonagenarians (≥90 years).
- STEMI management in the very elderly presents unique challenges and demographic profiles.
Purpose of the Study:
- To compare demographics, procedural details, and in-hospital outcomes of pPCI for STEMI between nonagenarians and patients younger than 90 years.
- To evaluate the safety and efficacy of pPCI in the nonagenarian population within a real-world setting.
Main Methods:
- Analysis of a prospective registry of 26,157 STEMI patients undergoing pPCI (2003-2011).
- Comparison of demographic characteristics, comorbidities, procedural approaches (radial vs. femoral access), stent use, and in-hospital outcomes between nonagenarians (n=418) and younger patients (n=25,739).
- Multivariable analysis to adjust for confounding factors influencing mortality.
Main Results:
- Nonagenarians were more likely to be female, nonsmokers, present with cardiogenic shock, and have significant comorbidities.
- High and similar angiographic success rates were observed in both groups (98.1% vs. 98.7%).
- Radial artery access was frequently used in both groups, with higher utilization in nonagenarians (72.1% vs. 61%). Drug-eluting stent use was significantly lower in nonagenarians (4.4% vs. 16.7%).
- Unadjusted and adjusted in-hospital mortality was significantly higher in nonagenarians (24.9% vs. 5.1%, OR 4.31).
Conclusions:
- Nonagenarians undergoing pPCI for STEMI exhibit distinct demographic profiles and present with more severe conditions.
- Despite high procedural success rates and frequent use of radial access, nonagenarians experience substantially higher in-hospital mortality.
- The findings underscore the need for careful consideration of risk-benefit in this extreme elderly population undergoing primary PCI.
Background:
Few data are available on primary percutaneous coronary intervention (pPCI) in nonagenarians. In a large prospective registry on pPCI for STEMI we compared the demographics, procedural and in-hospital outcomes between nonagenarians (age ≥ 90 years) and patients aged < 90 years.
Methods And Results:
We included 26,157 consecutive patients with pPCI in the Greater Paris Area region between 2003 and 2011. Of these, 418 (1.6%) were ≥ 90 years old. Nonagenarians (versus patients < 90 years) were more likely to be female (62.3% versus 22.5%, p < 0.0001), nonsmokers (81.6% versus 36.7%, p < 0.0001), in cardiogenic shock (Killip IV) upon admission (10.5% versus 4.8%, p < 0.001), and had significant co-morbidities. Over two-thirds of patients underwent procedures via the radial artery (61% versus 72.1%, p = 0.007). Both groups had high and similar angiographic success rates (98.1% versus 98.7%, p = 0.33). Drug-eluting stents were used less often in nonagenarians (4.4% versus 16.7%, p < 0.0001). Hospital mortality was significantly much higher in patients over 90 years old (24.9% versus 5.1%, p < 0.001) in univariate analysis. After adjustment for sex, cardiogenic shock, diabetes, triple vessel disease, drug-eluting stent use and glycoprotein IIb/IIIa inhibitors use, mortality remains higher in nonagenarian patients (OR: 4.31; 95% CI: 3.26-5.71, p < 0.0001).
Conclusions:
In a real-world setting, we found important demographic differences in nonagenarian compared to younger patients. Despite achieving a high rate of reperfusion with pPCI using mainly radial access, similar to that achieved in younger patients, hospital mortality was higher in nonagenarians.
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