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Primary PCI in a nonagenarian: an uncommon predicament

Sharath Babu Nelagondanahalli Manjunath1, Naveen Kumar Paramasivan2, Paul Valiavetil George2

  • 1Department of Cardiology, Christian Medical College and Hospital, Vellore, India nmsbabu18@yahoo.com.

BMJ Case Reports
|December 16, 2020
PubMed

Insights

Myocardial infarction in nonagenarians is a serious condition. This case study shows successful primary percutaneous coronary intervention in a nonagenarian with extensive anterior wall myocardial infarction, overcoming procedural challenges.

Area of Science:

  • Cardiology
  • Geriatric Medicine
  • Interventional Cardiology

Background:

  • Myocardial infarction (MI) in nonagenarians presents significant management challenges due to advanced age and comorbidities.
  • Optimal management strategies for MI in this demographic are not well-established, often leading to increased mortality.
  • Interventional approaches for MI in the very elderly are uncommon due to perceived risks and complexities.

Observation:

  • A 90+ year-old patient presented with an extensive anterior wall ST-elevation myocardial infarction (STEMI).
  • The patient had multiple comorbidities and potential logistical challenges for invasive management.
  • Despite anticipated periprocedural and intraprocedural difficulties, the decision was made for primary percutaneous coronary intervention (PCI).

Findings:

  • Primary percutaneous coronary intervention (PCI) was successfully performed in this nonagenarian patient.
  • The procedure navigated significant periprocedural and intraprocedural complexities.
  • The patient achieved successful revascularization of the infarct-related artery.

Implications:

  • Percutaneous coronary intervention (PCI) can be a viable and successful treatment option for myocardial infarction (MI) in nonagenarians.
  • Careful preprocedural assessment and tailored periprocedural management can overcome challenges in this patient group.
  • Successful revascularization in nonagenarians with MI may improve outcomes and warrants further investigation.

Keywords:
interventional cardiologyischaemic heart disease

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