Primary PCI in the very elderly: A study of outcomes in patients aged > 85 years with STEMI

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background Primary percutaneous coronary intervention (PPCI) as management for acute STEMI is a well-established, evidence-based treatment offered across India. Evidence of benefit in the very elderly is sparse. With an aging population, the demand on PPCI services for STEMI in the elderly is likely to increase. Our aim was to establish real life outcomes in patients aged 85 years and older who receive PPCI for acute STEMI. Methods Data was collected retrospectively on all patients aged 85 years and older who were referred and accepted for PPCI to our centre between 2015 and 2019. This represented 11.2% (N = 572) of all accepted PPCI referrals over the 4-year period. Results 64 patients proceeded to invasive angiography, of whom 43 patients received PPCI. PPCI was successful in over 95% of cases. Median hospital stay of all patients was 5 days (range 3– 15). 38 patients survived STEMI admission (88.4%). 94% of patients who survived admission were discharged to their own home, and 72% were functionally independent. One-year mortality was 33.7%. Median survival of all patients post-STEMI was 3.45 years. Conclusions Advanced age should not be used as an exclusion criterion in isolation for PPCI. Rather, a personalised approach that takes into account all clinically relevant patient factors should be adopted to guide PCI decision-making. Despite relatively long hospital stays and high 1-year mortality, there are still potential good quality life years to be gained following intervention. Our findings therefore suggest that emergency revascularization therapy as first-line treatment for STEMI in the very elderly should be considered routinely