Primary percutaneous coronary intervention for ST elevation myocardial infarction in nonagenarians
Thibaut Petroni1, Azfar Zaman2, Jean-Louis Georges3
1Cardiology Institute, Pitié-Salpêtrière Hospital, UPMC, APHP, Paris, France.
Insights
Primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) is feasible in nonagenarians. This approach shows good reperfusion rates and 53% survival at one year, suggesting it can be offered to selected elderly patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Geriatric Cardiology
Background:
- ST-segment elevation myocardial infarction (STEMI) in nonagenarians presents unique challenges.
- Outcomes of primary percutaneous coronary intervention (PCI) in this extreme age group are not well-established.
Purpose of the Study:
- To assess the feasibility and outcomes of primary PCI for STEMI in patients aged 90 years and older.
- To evaluate short-term and long-term survival rates following primary PCI in this cohort.
Main Methods:
- A multicentre retrospective study included 145 consecutive nonagenarian patients treated with primary PCI for STEMI.
- Data on demographics, clinical presentation, procedural details, and clinical events were collected.
- Mortality and severe clinical events were assessed at 6 months and 1 year post-procedure.
Main Results:
- Primary PCI was successfully achieved in 86% of cases, with a transradial approach used in 60%.
- In-hospital mortality was 24%, with 6-month and 1-year survival rates of 61% and 53%, respectively.
- Major bleeding occurred in 4% of patients, and median ejection fraction post-PCI was 41.5%.
Conclusions:
- Primary PCI is a feasible and effective treatment for STEMI in nonagenarians.
- The transradial approach is well-tolerated in this population.
- Selected nonagenarian patients with STEMI may benefit from primary PCI, offering a survival rate of 53% at one year.
Objective:
To assess outcomes following primary percutaneous coronary intervention (PCI) for ST-segment elevation acute myocardial infarction (STEMI) in nonagenarian patients.
Methods:
We conducted a multicentre retrospective study between 2006 and 2013 in five international high-volume centres and included consecutive all-comer nonagenarians treated with primary PCI for STEMI. There were no exclusion criteria. We enrolled 145 patients and collected demographic, clinical and procedural data. Severe clinical events and mortality at 6 months and 1 year were assessed.
Results:
Cardiogenic shock was present at admission in 21%. Median (IQR) delay between symptom onset and balloon was 3.7 (2.4-5.6) hours and 60% of procedures were performed through the transradial approach. Successful revascularisation of the culprit vessel was obtained in 86% of the cases (thrombolysis in myocardial infarction flow of 2 or 3). Major or clinically relevant bleeding was observed in 4% of patients. Median left ventricular ejection fraction post PCI was 41.5% (32.0-50.0). The in-hospital mortality was 24%, with 6 months and 1-year survival rates of 61% and 53%, respectively.
Conclusions:
In our study, primary PCI in nonagenarians with STEMI was achieved and feasible through a transradial approach. It is associated with a high rate of reperfusion of the infarct-related artery and 53% survival at 1 year. These results suggest that primary PCI may be offered in selected nonagenarians with acute myocardial infarction.
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