Primary percutaneous coronary intervention in nonagenarians: is it worthwhile?

Area of Science:

• Cardiology
• Geriatric Medicine
• Interventional Cardiology

Background:

• Guidelines recommend revascularization for ST-elevation myocardial infarction (STEMI).
• The benefit of primary percutaneous coronary intervention (PPCI) in nonagenarians remains unclear.
• Previous studies show PPCI feasibility in selected nonagenarians.

Purpose of the Study:

• To compare mortality rates in nonagenarians with acute myocardial infarction (AMI).
• To evaluate outcomes between PPCI and medical management in nonagenarians presenting via the PPCI pathway.

Main Methods:

• Retrospective analysis of 111 nonagenarians with AMI between July 2013 and December 2018.
• Comparison of all-cause mortality between patients undergoing PPCI (n=42) and those managed medically (n=69).
• Kaplan-Meier survival analysis for 30-day and 3-year mortality.

Main Results:

• STEMI was diagnosed in 88.3% of patients; NSTEMI in 11.7%.
• PPCI was performed in 37.8%, while 62.2% received medical management.
• A trend towards increased 30-day mortality was observed in the medically managed group (40.6% vs 23.8%).
• Significant 3-year survival benefit for PPCI (48.1% vs 21.7%, p=0.01), even after excluding completed infarcts.

Conclusions:

• In selected nonagenarians with AMI, PPCI is associated with lower mortality.
• PPCI may be a beneficial treatment strategy for elderly patients with acute myocardial infarction.