Results of percutaneous coronary interventions in patients ≥90 years of age

Abstract

There are few data about percutaneous coronary interventions (PCI) in nonagenarians (patients aged > or =90 years). This study aimed to assess acute and intermediate term clinical outcomes among nonagenarian patients undergoing PCI. The study included 65 consecutive patients, age > or =90 years undergoing PCI between January 2001 and August 2006. Fourteen patients were admitted with acute ST elevation acute myocardial infarction (STEAMI), one had cardiogenic shock, 39 patients sustained non-STEAMI, and 12 patients were with severe stable angina pectoris. Procedural data, in-hospital, and six-month clinical outcomes were obtained and adjudicated for all patients. Coronary angiography documented multivessel disease in 86% of patients with relatively complex lesions (type B or C) in 94% treated using stent deployment in 92% of patients. In 7% of cases IABP was needed. Immediate procedural success was achieved in 92% patients. Cumulative mortality at hospital discharge and by 30-days was 14% and increased to 18% at 6-months follow-up. Total major adverse cardiac events (MACE: death, AMI, TVR, stroke) was 17% at hospital discharge and increased to 21% by 6-months. Stroke was documented in one patient (1.5%) at hospital discharge. Cumulative mortality at 6 month was 0% in patients with stable angina and 23% in emergent PCI scenario (AMI or NSTEAMI or ACS). Univariate analysis revealed that emergent PCI, systolic blood pressure, left ventricular ejection fraction, diabetes mellitus, renal failure, TIMI flow at baseline, and procedural success, are all correlative with 6-months mortality. We conclude that clinically stable nonagenarian patients with coronary artery disease undergoing PCI have excellent PCI related prognosis while clinically unstable patients have a worse outcome. Thus, careful attention to background medical history and clinical presentation should dictate the prognosis and/or management among nonagenarian patients.