048: Is primary PCI feasible in nonagenarians?

Abstract

The reperfusion strategy requiring primary percutaneous coronary intervention (PPCI) for ST-segment elevation acute myocardial infarction (STEMI) in nonagenarian patients remains controversial. The purpose of this study was to evaluate the results and the outcome of PPCI in patients aged 90 years old or more with STEMI. We conducted a monocentric retrospective study over the past 8 years and focused on nonagenarians treated with PPCI for STEMI. We enrolled 34 patients with STEMI who were treated with PPCI. Mean age was 92.7±2,5 years, 74% were women. Cardiogenic shock was present at admission in 9 (26%) of these patients, acute pulmonary oedema was diagnosed in 10 (29%) of them and 2 (6%) had severe conduction disorder. Mean delay between symptom onset and balloon was 92±12.7 hours and 29 patients (83%) underwent PCI through transradial approach. Among these patients, 16 (46%) had monotroncular coronary heart disease and 31 (89%) had single-vessel PCI (3% LM, 53% LAD, 15% CX and 29% RCA). Revascularization procedure of the culprit vessel was successful in 88% of the cases (TIMI flow of 2 or 3). Bare-metal stents were implanted in 30 cases (94%) versus in 1 case (3%) for drug-eluting stents. Distal embolization occurred in 2 patients (6%) and acute coronary dissection occurred in 2 other cases (6%) but only one patient (3%) had severe bleeding despite the use of clopidogrel in 31 cases (89%) and anti-GpIIb-IIIa in 17 cases (50%). None had intra-aortic counterpulsation support. Mean cardiac troponine Ic was 90±105 ng/ml and mean LVEF post-PCI was measured at 43±14%. Mean hospital stay was 4.8±4.6 days and in-hospital mortality rate was 24%. In our study, PPCI in nonagenarians with STEMI is successful and feasible through a transradial approach. It is associated with high rate of successful reperfusion of the infarct-related artery. These results suggest that PPCI should be offered in selected nonagenarians with STEMI.