Percutaneous coronary intervention in nonagenarians

Due to aging population, nonagenarians are increasingly undergoing percutaneous coronary intervention (PCI). However, the safety and efficacy of PCI in this elderly population remains somewhat unknown.

A retrospective study was conducted to investigate the characteristics and outcomes of consecutive nonagenarians who underwent PCI at the Oulu University Hospital between 2012 and 2022. Patients (n = 107; mean age 91.2 ± 1.4 years; 58.9% women) were stratified into three groups based on their presentation: ST-elevation myocardial infarction (STEMI), non-ST-elevation acute coronary syndrome (NSTEACS) or stable coronary artery disease (CAD). One-year mortality was the primary outcome of this analysis. Secondary outcomes were in-hospital major bleeding and 1-year rates of myocardial infarction, stroke and repeat revascularisation.

Majority had acute coronary syndrome, with STEMI in 35 (32.7%) and NSTEACS in 51 (47.7%) patients, while in 21 (19.6%) patients' indication was stable CAD. Early mortality was mainly related to STEMI (in-hospital mortality: STEMI 22.9% vs. NSTEACS 5.9% vs. stable CAD 0.0%, p = 0.011; 30-day mortality: 34.3% vs. 13.7% vs. 4.8%, respectively, p = 0.011). Rate of major in-hospital bleeding was 3.7%. There was no significant difference in 1-year mortality between groups (40.0% vs. 27.5% vs. 19.0%, respectively, p = 0.227). One-year rates for myocardial infarction, stroke and repeat revascularisation were 7.5%, 1.9% and 3.7%, respectively.

Excess mortality in nonagenarians undergoing PCI is mainly related to STEMI where it is driven by early adverse events. Mortality in this study can be seen as acceptable in comparison to that in general population, supporting the use of PCI in selected nonagenarians.