Comorbidities and Complications in Nonagenarians Undergoing Coronary Angiography and Intervention

Elderly people represent the fastest growing portion of cardiovascular patients. We aimed to analyze the clinical presentation, risk factors, co-morbidities, complications, and mortality in patients 90 years or more who underwent coronary angiography and intervention.We retrospectively studied 108 (0.25% of 43,385) consecutive patients ≥ 90 years undergoing cardiac catheterization and/or intervention in a tertiary specialist hospital between 2003 and 2014.Most patients (68.5%) were introduced on an emergency basis, especially with acute coronary syndrome (ACS) (63.8%). Non-STEMI accounted for two-thirds of the myocardial infarctions. We found higher prevalences of previous coronary artery disease (CAD) (38%), other atherosclerotic diseases (20.4%), cardiac risk factors such as hypertension (84.3%), diabetes (49.1%), hyperlipidemia (50.9%), heart failure (42.6%), atrial fibrillation (AF) (25.0%), severe aortic stenosis (13.0%), severe mitral regurgitation (3.7%), and implantable devices (25.0%), and co-morbidities such as renal impairment (48.1%), COPD (12.0%), and previous stroke (6.5%). Three-vessel disease was present in 34.6% of the patients. The left anterior descending artery (LAD) was the most affected coronary artery (67.6%). Percutaneous coronary intervention (PCI), mostly with bare metal stents (BMS), was used to manage 54.6% of the patients, and it failed in 4 of the patients. Conservative treatment was used in 39.8% of the patients and 15.7% had no significant CAD.The incidences of vascular complications, such as bleeding (6.5%), bleeding in other organs (6.5%), blood transfusion (6.5%), in-hospital paroxysmal atrial fibrillation (7.4%), in-hospital successful reanimation (2.8%), complete heart block (5.6%), acute renal impairment (23.1%), associated infection (25.9%), cardiogenic shock (14.8%), and death (15.7%) were high.Considering the more extensive risk factors, CAD and co-morbidities, acute presentation and age per se, we believe that the reported higher rates of complications and mortality are still acceptable.