Percutaneous coronary intervention in nonagenarians with acute myocardial infarction: a 15-year population-based
Giancarlo Marenzi1, Nicola Cosentino2, Daniela Mele2
1Centro Cardiologico Monzino IRCCS, Via Parea 4, Milan, 20138, Italy. giancarlo.marenzi@ccfm.it.
Insights
Percutaneous coronary intervention (PCI) significantly reduces mortality and rehospitalization for acute myocardial infarction (AMI) in patients over 90 years old. These benefits persist regardless of patient comorbidities, supporting PCI use in this elderly population.
Area of Science:
- Cardiology
- Geriatric Medicine
- Interventional Cardiology
Background:
- Percutaneous coronary intervention (PCI) use in very elderly patients (over 90 years) with acute myocardial infarction (AMI) is debated due to limited evidence and high rates of multimorbidity.
- Optimal treatment strategies for AMI in this specific demographic remain unclear.
Purpose of the Study:
- To evaluate the impact and outcomes of PCI in patients aged 90 years and older diagnosed with AMI.
- To assess the association of PCI with in-hospital mortality, one-year mortality, and rehospitalization rates in this vulnerable population.
Main Methods:
- Retrospective analysis of the Lombardy Health Database (Italy) including AMI patients hospitalized between 2003 and 2018.
- Comparison of outcomes between patients who underwent PCI and those who did not, utilizing adjusted risk analyses and propensity score matching.
- Subgroup analysis for ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) patients.
Main Results:
- PCI was performed in 12% of 15,954 AMI patients (median age 92).
- PCI-treated patients showed lower in-hospital mortality (15% vs. 23%) and one-year mortality (37% vs. 58%).
- Rehospitalization rates for acute heart failure or AMI were also reduced in PCI recipients (16% vs. 21%), irrespective of comorbidities.
Conclusions:
- PCI is associated with significantly improved survival and reduced rehospitalization in patients over 90 years with AMI.
- The benefits of PCI were observed consistently across STEMI and NSTEMI subgroups and were independent of comorbidities.
- Findings support the consideration of PCI in very elderly AMI patients, challenging previous debates on its utility in this age group.
Abstract:
The use of percutaneous coronary intervention (PCI) in very elderly patients (> 90 years) with acute myocardial infarction (AMI) remains debated due to limited evidence and the presence of multimorbidity. This study evaluated the impact of PCI using data from the Lombardy Health Database (Italy) for AMI patients hospitalized between 2003 and 2018. Among 15,954 patients (median age 92; 71% female; 50% with ST-elevation myocardial infarction [STEMI]), 12% underwent PCI. In-hospital mortality was lower in PCI-treated patients (15% vs. 23%; P < 0.0001). Overall, one-year mortality (56%) and rehospitalization for acute heart failure (AHF) or AMI (19%) were also reduced among PCI patients (37% vs. 58% and 16% vs. 21%, respectively; P < 0.0001). These findings were consistent across both STEMI and non-ST-elevation myocardial infarction (NSTEMI) subgroups and were independent of comorbidities. Adjusted risk analyses and propensity score matching (1,950 patients per group) confirmed these benefits. The use of PCI increased significantly from 4% in 2003 to 22% in 2018, while in-hospital mortality declined from 22 to 19% (from 28 to 15% in the propensity-matched cohort). In conclusion, PCI was associated with significantly lower in-hospital and one-year mortality, as well as reduced rehospitalization rates, in AMI patients older than 90 years, regardless of comorbidities.
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