Percutaneous Coronary Intervention In Nonagenarians Research Articles

Abstract 17263: Outcomes and Trends of Percutaneous Coronary Intervention in Nonagenarians With Acute Myocardial Infarction: Results From National Inpatient Sample 2016-2020

Background: Acute myocardial infarction (MI) is a leading cause of mortality and morbidity among the elderly. Multiple co-morbidities and advanced age often impede the need for cardiac catheterization in these patients. The literature studying percutaneous coronary intervention (PCI) in nonagenarian patients with acute MI is limited. Methods: We examined hospitalized acute MI patients with age 90 or above that were included in the National Inpatient Sample 2016-2020. Acute MI was defined by using the International Classification of Diseases -10. Patients aged less than 90 years were excluded. Outcomes were expressed as percentages. Multivariable logistic regression analysis was used to examine the association of PCI and age 90 or above with primary outcome of mortality, and secondary outcomes [ Figure1]. We also studied the yearly trends of PCI in nonagenarian patients with acute MI patients. Results: Of the total hospitalized patients with acute MI (n = 3,120,759), 4.6% (n=142,675) patients were aged 90 years or above. Of these, 9.4% (n= 3,615) died in PCI group and 12.7% (n= 13,215) died in non - PCI group. PCI was performed in 27% (n= 38,430) of the nonagenarian patients with acute MI. The most common outcomes in PCI group were acute heart failure (37.5%), Acute kidney injury (28 %), and atrial arrhythmia (23%). PCI in nonagenarian patients with acute MI was associated with decreased odds of mortality (OR 0.75, 95% CI 0.68-0.82, p value <0.001) and having any of the secondary outcomes (OR 0.74, 95% CI 0.69- 0.79, p value <0.001) [Figure 1]. From 2016-2020, there are increasing yearly trends of PCI in nonagenarian patients with acute MI (p value <0.001). Conclusion: Acute MI in elderly patients is associated with significant increased mortality and adverse events. PCI in acute MI patients with age 90 years or above was associated with decreased odds of mortality.

One-year outcome after percutaneous coronary intervention in nonagenarians: Insights from the J-PCI OUTCOME registry

Nonagenarian patients who undergo percutaneous coronary intervention (PCI) are increasing, and a few previous studies have reported their long-term outcomes. However, differences in their long-term outcomes between generations remain unclear. This study aimed to investigate 1-year all-cause and cardiovascular (CV) mortality, and major adverse cardiovascular events (MACE; cardiovascular death, myocardial infarction, and stroke) of nonagenarian patients who underwent PCI compared with the other elder patients, using a nationwide registration system. The patient-level data registered between January 2017 and December 2017 was extracted from the J-PCI OUTCOME Registry endorsed by the Japanese Association of Cardiovascular Intervention and Therapeutics (CVIT). The one-year all-cause and cardiovascular (CV) mortality, MACE, and major bleeding events were identified. Out of 40,722 patients over 60 years of age, 880 (2.1%) were nonagenarians. For nonagenarians, the 1-year mortality rate was substantial (13.5%). The MACE and CV death rates were also high (8.1%, and 6.8%, respectively) for nonagenarians, and these event rates were approximately 1.5 times higher in nonagenarians than octogenarians. Multivariate regression analysis showed that presentation with cardiogenic shock [hazard ratio (HR) 2.32; 95 confidence intervals (CI): 1.22-4.41], or cardiac arrest (HR 2.91; 90% CI: 1.28-6.62), and use of oral anticoagulants (HR 2.10; 90% CI: 1.07-4.12) were the predictors of 1-year MACE. Even in the contemporary era, nonagenarians who have undergone PCI still face a considerably increased risk for adverse cardiovascular events that reduces long-term survival. In addition to having poorer lesion characteristics, adverse events, including death, MACEs, and major bleeding, occurred 1.5 times more frequently in nonagenarians than in octogenarians.

Abstract 10833: 30-Day Readmissions After Primary Percutaneous Coronary Intervention in Nonagenarians: A Nationwide Analysis from the United States

Objective: To assess 30-day readmission rates and mortality at readmission in nonagenarians following primary percutaneous coronary intervention (pPCI) for ST elevation myocardial infarction (STEMI). Background: There is limited contemporary data exploring the 30-day readmission rates and mortality in nonagenarians (age greater than 90 years) with STEMI following pPCI when compared to no pPCI. Methods: We utilized the National Readmissions Database (NRD) from 2010 to 2018 to identify nonagenarians hospitalized with STEMI. We divided the total cohort into two groups based on pPCI status. We analyzed 30-day readmission rates, mortality at the time of readmission, and causes of readmissions in both study cohorts. Results: Between 2010-2018, an estimated 37,363 STEMI hospitalizations were identified in nonagenarians, of which 12,062 (32.3%) included pPCI and 25,301 (67.7%) had no pPCI. Compared to pPCI cohort, no pPCI had more women (69.8% vs 36.7%), higher elixhauser comorbidity index (13% vs 8%), palliative care consultation (12.6% vs 3.4%), and nursing home placement (48% vs 33.3%) (all p<0.01). Overall, 30-day readmission rates were higher in pPCI cohort compared with no pPCI (22.1% vs 16.2%; p<0.01). However, the in-hospital mortality rates at 30-day readmission were significantly lower in pPCI cohort compared with no pPCI (7.0% vs 14.3%; p<0.01). Heart failure is the most common cause of 30-day readmissions in both cohorts, followed by acute myocardial infarction (MI) and gastrointestinal hemorrhage. Recurrent MI rates were significantly lower in pPCI cohort compared with no pPCI (12.3% vs 18.4%; p<0.01). Conclusion: In nonagenarians with STEMI, pPCI during index hospitalization is associated with slightly higher 30-day readmissions but significantly lower mortality at the time of readmission. Given the remarkable mortality benefit with pPCI, further research is necessary to risk stratify and optimize readmission rates following STEMI in nonagenarians.

Primary percutaneous coronary intervention in nonagenarians: is it worthwhile?

BackgroundPrevious studies have demonstrated the feasibility of primary percutaneous coronary intervention (PPCI) in carefully selected nonagenarians. Although current guidelines recommend immediate revascularization in patients with ST elevation myocardial infarction (STEMI) it remains unclear whether PPCI reduces mortality in nonagenarians. The objective of this study is to compare mortality in nonagenarians presenting via the PPCI pathway who undergo coronary intervention, versus those who are managed medically.Methods and resultsA total of 111 consecutive nonagenarians who presented to our tertiary center via the PPCI pathway between July 2013 and December 2018 with myocardial infarction were included. Clinical and angiographic details were collected alongside data on all-cause mortality. The final diagnosis was STEMI in 98 (88.3%) and NSTEMI in 13 (11.7%). PPCI was performed in 42 (37.8%), while 69 (62.2%) were medically managed. A significant number of the medically managed cohort had atrial fibrillation (23.2% vs 2.4% p = 0.003) and presented with a completed infarct (43.5% vs 4.8% p = 0.001). Other baseline and clinical variables were well matched in both groups. There was a trend towards increased 30-day mortality in the medically managed group (40.6% vs 23.8% p = 0.07). Kaplan Meier survival analysis demonstrated a significant difference in survival by 3 years (48.1% vs 21.7% p = 0.01). This was the case even when those with completed infarcts were excluded (44.3% vs 14.6%, p = 0.01).ConclusionIn this series of selected nonagenarians presenting with acute myocardial infarction, those undergoing PPCI appeared to have a lower mortality compared to those managed medically.

Temporal Trends and Outcomes of Percutaneous Coronary Interventions in Nonagenarians: A National Perspective

ObjectivesThis study sought to assess temporal trends and outcomes of percutaneous coronary intervention (PCI) in nonagenarians. BackgroundWith increasing life expectancy, nonagenarians requiring PCI are increasing even though outcomes data are limited. MethodsThe National Inpatient Sample was used to identify all hospitalizations for PCI in patients aged ≥90 years from January 1, 2003, to December 31, 2014. The primary outcome was in-hospital mortality. ResultsNonagenarians (n = 69,271) constituted 0.9% of all PCI hospitalizations, increasing from 0.6% in 2003 to 2004 to 1.4% in 2013 to 2014 (ptrend < 0.001). From 2003–2004 to 2013–2014, the proportion of PCIs performed for ST-segment elevation myocardial infarction (STEMI) (23.1% to 30.9%) and non-ST-segment elevation acute coronary syndromes (49.6% to 52.6%) increased, whereas those for stable ischemic heart disease (SIHD) decreased (27.3% to 16.5%), respectively (ptrend < 0.001 for all). Overall in-hospital mortality after PCI for STEMI, non-ST-segment elevation acute coronary syndromes, and SIHD were 16.4%, 4.2%, and 1.8%, respectively. After multivariable risk adjustment for demographics, comorbidities, and hospital-level characteristics, in-hospital mortality remained unchanged in STEMI (odds ratio: 1.04; 95% confidence interval: 0.98 to 1.11; ptrend = 0.20) and non-ST-segment elevation acute coronary syndromes (odds ratio: 0.99; 95% confidence interval: 0.91 to 1.08; ptrend = 0.82), but increased in SIHD (odds ratio: 1.21; 95% confidence interval: 1.01 to 1.44; ptrend = 0.04) from 2003 to 2004 to 2013 to 2014. The rates of bleeding and vascular complications decreased or remained stable in all 3 subgroups, whereas risk-adjusted incidence of stroke increased in patients with STEMI or SIHD. ConclusionsThe rate of in-hospital mortality, major bleeding, vascular complications, and stroke after PCI in nonagenarians changed significantly from 2003 to 2014. This study provides a benchmark for discussion of PCI-related risks among physicians, patients, and families.

TCT-246 Temporal Trends and Outcomes of Percutaneous Coronary Interventions in Nonagenarians – A National Perspective

TCT-246 Temporal Trends and Outcomes of Percutaneous Coronary Interventions in Nonagenarians – A National Perspective

Percutaneous Coronary Intervention in Nonagenarians: Prevalence, Indications, Vascular Approach and Mortality at 3 months

Background: Percutaneous coronary intervention (PCI) in nonagenarians has been shown to be feasible, with a high success rate. However, there is paucity of data regarding the prevalence, vascular access, procedural data and mortality after PCI in this population. Methods: All patients aged 90 and older referred to our institution from 2004 to 2014 for coronary angiogram were included in our retrospective study. Clinical and procedural data including vascular access and 3-month mortality rates were obtained for all patients. Results: A total of 26696 PCI were performed over the last 11 years, of which 177 PCI (0.66%) were realized in 167 nonagenarians. The prevalence of PCI in nonagenarians increased from 0.17% in 2004 to 1.22% in 2014. In this population, with an age of 92 ± 2 years and 51.4% of males, 76 (43%) PCI were performed in the setting of ST-elevation myocardial infarction, and 89 (50%) of the procedures were non-ST elevation myocardial infarction or unstable angina. Transradial approach (TRA) was used in 76 (43%) and transfemoral approach (TFA) in 101 (57%) procedures. Comparing TRA to TFA, the total fluoroscopic time and contrast volume was similar between the two groups. Overall complications, including cardiogenic shock, iatrogenic coronary dissection, perforation or no reflow phenomenon occurred in 22 of 177 procedures (12.4%). Overall survival rate was 92.8% at 3 months. Conclusion: The majority of the procedures was performed in acute coronary syndrome clinical setting. TRA and TFA were comparable in terms of fluoroscopic time and contrast volume. Overall procedural success rate was high and complication rates were low.

Temporal trends and in-hospital outcomes of primary percutaneous coronary intervention in nonagenarians with ST-segment elevation myocardial infarction.

Background/Aims:Data regarding the outcomes of primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) in nonagenarians are very limited. The aim of the present study was to evaluate the temporal trends and in-hospital outcomes of primary PCI in nonagenarian STEMI patients.Methods:We retrospectively reviewed data from the Korea Acute Myocardial Infarction Registry (KAMIR) from November 2005 to January 2008, and from the Korea Working Group on Myocardial Infarction (KorMI) from February 2008 to May 2010.Results:During this period, the proportion of nonagenarians among STEMI patients more than doubled (0.59% in KAMIR vs. 1.35% in KorMI), and the rate of use of primary PCI also increased (from 62.5% in KAMIR to 81.0% in KorMI). We identified 84 eligible study patients for which the overall in-hospital mortality rate was 21.4% (25.0% in KAMIR vs. 20.3% in KorMI, p = 0.919). Multivariate analysis identified two independent predictors of in-hospital mortality, namely a final Thrombolysis in Myocardial Infarction (TIMI) flow < 3 (odds ratio [OR], 13.7; 95% confidence interval [CI], 3.2 to 59.0; p < 0.001) and cardiogenic shock during hospitalization (OR, 6.7; 95% CI, 1.5 to 30.3; p = 0.013).Conclusions:The number of nonagenarian STEMI patients who have undergone primary PCI has increased. Although a final TIMI flow < 3 and cardiogenic shock are independent predictors of in-hospital mortality, primary PCI can be performed with a high success rate and an acceptable in-hospital mortality rate.

Outcomes of primary percutaneous coronary interventions in nonagenarians with acute myocardial infarction

BackgroundFew data are available on primary percutaneous coronary intervention (pPCI) in nonagenarians. In a large prospective registry on pPCI for STEMI we compared the demographics, procedural and in-hospital outcomes between nonagenarians (age ≥ 90years) and patients aged <90years. Methods and resultsWe included 26,157 consecutive patients with pPCI in the Greater Paris Area region between 2003 and 2011. Of these, 418 (1.6%) were ≥90years old. Nonagenarians (versus patients <90years) were more likely to be female (62.3% versus 22.5%, p<0.0001), nonsmokers (81.6% versus 36.7%, p<0.0001), in cardiogenic shock (Killip IV) upon admission (10.5% versus 4.8%, p<0.001), and had significant co-morbidities. Over two-thirds of patients underwent procedures via the radial artery (61% versus 72.1%, p=0.007). Both groups had high and similar angiographic success rates (98.1% versus 98.7%, p=0.33). Drug-eluting stents were used less often in nonagenarians (4.4% versus 16.7%, p<0.0001). Hospital mortality was significantly much higher in patients over 90years old (24.9% versus 5.1%, p<0.001) in univariate analysis. After adjustment for sex, cardiogenic shock, diabetes, triple vessel disease, drug-eluting stent use and glycoprotein IIb/IIIa inhibitors use, mortality remains higher in nonagenarian patients (OR: 4.31; 95% CI: 3.26–5.71, p<0.0001). ConclusionsIn a real-world setting, we found important demographic differences in nonagenarian compared to younger patients. Despite achieving a high rate of reperfusion with pPCI using mainly radial access, similar to that achieved in younger patients, hospital mortality was higher in nonagenarians.

Retrospective multicenter observational study of the interventional management of coronary disease in the very elderly: The NINETY

Objectives: The aim of this observational, multicenter study was to describe the outcome of very elderly patients undergoing percutaneous coronary intervention (PCI). Background: There is a paucity of data among nonagenarians undergoing PCI. Methods: All consecutive patients 90 years of age or older undergoing PCI with stent implantation between April 2002 and June 2009 were included in the study. The primary endpoint was the long term rate of net adverse cardiac events (NACE), that is, death, myocardial infarction (MI), target lesion revascularization, and life threatening or major bleedings. Results: One hundred forty-six nonagenarians were divided in three groups according to clinical setting: 27 (group A) stable angina or silent ischemia, 85 (group B) unstable angina or non-ST elevation MI, and 34 (group C) with ST elevation MI (STEMI). At 30 days, the incidence of NACE was significantly lower in patients in Group A vs. B or C (0% vs. 17.3% vs. 31.2%, p = 0.006), and the frequency of definite stent thrombosis was higher in Group C vs. A or B (9.4% vs. 0% vs. 0%, p = 0.007), respectively. Up to a median follow up of 24 months, NACE rate was 33.3% in group A, 49.3% in group B, and 50% in group C (p = 0.32). There were no significant differences between groups in the individual components of the primary endpoint. Conclusions: PCI in nonagenarians is safe and feasible with acceptable major bleeding rates. However, long term results show high mortality rates particularly in the STEMI group.

Intérêts et limites de la stratégie invasive coronaire chez les patients nonagénaires

BackgroundNonagenarians are systematically excluded from studies of interventional cardiology. Few data exist on the usefulness, safety, and results of coronary angiography (CA) and percutaneous coronary intervention (PCI) in this population. PurposeTo evaluate the benefits and hazards of CA and PCI in nonagenarians. MethodsRetrospective study conducted from the database (Cardioreport®) of the CH de Versailles, from January 2001 to December 2011. ResultsFrom the 15,806 procedures performed in the center during the period, 107 (0.9%) were done in 97 patients aged ≥90years. Half of them underwent PCI. Median age was 92±2years (range: 90 to 100), 56% were women. Main indication was an acute coronary syndrome (77%, acute STEMI in 39%). The first group (n=58) had a single CA leading to strengthen medical treatment, and CABG in one case. The second group (n=49) had a CA followed by immediate (41) or delayed (8) PCI. The primary success rate of PCI was 90%. Radial route was used in 94% in the period 2009–2011 (51% overall). Failure of arterial access (4%) and difficulties of catheterization (13%) were rare. Severe complications occurred in 19%. They were local (11 hematomas, 6 severe, 4 transfusions, and 1 fatal acute ischemia of a lower limb), and general (1 stroke, 1 death by left main rupture during PCI). Twenty percent of the complications (11% of severe ones) were directly related to the procedure. Overall hospital mortality was 10%. ConclusionsAngiography is feasible in nonagenarians by radial approach without failures and with a reduced rate of complications. PCI was indicated in about half of the cases. PCI may be proposed in nonagerians with a high success rate, and an acceptable risk of local and general complications.

Retrospective multicenter observational study of the interventional management of coronary disease in the very elderly: The NINETY

The aim of this observational, multicenter study was to describe the outcome of very elderly patients undergoing percutaneous coronary intervention (PCI). There is a paucity of data among nonagenarians undergoing PCI. All consecutive patients 90 years of age or older undergoing PCI with stent implantation between April 2002 and June 2009 were included in the study. The primary endpoint was the long-term rate of net adverse cardiac events (NACE), that is, death, myocardial infarction (MI), target lesion revascularization, and life-threatening or major bleedings. One hundred forty-six nonagenarians were divided in three groups according to clinical setting: 27 (group A) stable angina or silent ischemia, 85 (group B) unstable angina or non-ST elevation MI, and 34 (group C) with ST elevation MI (STEMI). At 30 days, the incidence of NACE was significantly lower in patients in Group A vs. B or C (0% vs. 17.3% vs. 31.2%, P = 0.006), and the frequency of definite stent thrombosis was higher in Group C vs. A or B (9.4% vs. 0% vs. 0%, P = 0.007), respectively. Up to a median follow-up of 24 months, NACE rate was 33.3% in group A, 49.3% in group B, and 50% in group C (P = 0.32). There were no significant differences between groups in the individual components of the primary endpoint. PCI in nonagenarians is safe and feasible with acceptable major bleeding rates. However, long-term results show high mortality rates particularly in the STEMI group.

Percutaneous coronary intervention in nonagenarians: pros and cons.

Percutaneous coronary intervention is a mainstay in the management of symptomatic or high-risk coronary artery disease. The bulk of clinical evidence and experience underlying this fact relies, however, on relatively young patients. Indeed, few data of very limited quality are available which adequately define the risk-benefit and cost-benefit profile of coronary angioplasty and stenting in very old subjects, such as those of 90 years of age or older (i.e., nonagenarians). The aim of this review is to provide a concise, yet practical, synthesis of the available evidence on percutaneous coronary revascularization in the very elderly. The main arguments elaborated upon are to what extent we can extrapolate findings from studies including younger patients to nonagenarians, whether we should provide higher priority to prognosis or quality of life in such patients, and whether we can afford to allocate vast resources to care for such subjects in an era of financial constraints. Our review of 18 studies and 1082 patients suggest that percutaneous coronary intervention is feasible and associated with acceptable short- and long-term results in this population, which is nonetheless fraught with a high mortality risk irrespective of the revascularization procedure. Accordingly, the pros and cons of percutaneous coronary intervention should be carefully weighed when considering this treatment in nonagenarians.

TCT-409: Long-Term Clinical Follow-Up Of Percutaneous Coronary Intervention In Nonagenarians

TCT-409: Long-Term Clinical Follow-Up Of Percutaneous Coronary Intervention In Nonagenarians

Primary percutaneous coronary intervention for ST-segment elevation acute myocardial infarction in nonagenarian patients: results from a Spanish multicentre registry

Data on primary percutaneous coronary intervention for ST-segment elevation in nonagenarian patients are very limited. Our aim was to evaluate the results of primary percutaneous coronary intervention in patients ≥ 90 years old with ST-segment elevation acute myocardial infarction. We conducted a multicentre registry focused on nonagenarians treated with percutaneous coronary interventions, gathering data from five tertiary centres in Spain. We included 38 patients with ST-segment elevation acute myocardial infarction who presented within 12 hours after symptoms onset and who were treated with primary percutaneous intervention. Mean age was 91.5 (90-98). Angiographic success was achieved in 90%, and TIMI 3 flow in 76% of cases. In-hospital mortality was 34.2%, concentrated in patients with major bleeding (100% vs. 31.4%), final TIMI flow grade <3 (71.4% vs. 22.7%), and Killip class > I at admission (53.3% vs. 21.7%). Primary percutaneous coronary intervention in nonagenarians with ST-segment elevation acute myocardial infarction is associated with high rate of successful recanalisation of the infarct-related artery. Mortality is concentrated in patients with severe bleeding during hospitalisation, heart failure at admission, and final TIMI flow <3.

Midterm Outcomes and Quality of Life Following Percutaneous Coronary Intervention in Nonagenarians

The midterm clinical and functional benefits of percutaneous coronary intervention in patients aged ≥90 years have not been clearly defined. From January 2005 to June 2009, 173 patients aged ≥90 years underwent diagnostic cardiac catheterization, of whom 90 underwent percutaneous coronary intervention. There were 45 men (50%) and 45 women (50%), with a mean age of 92 years (range 90 to 101). Of these, 24 patients (27%) presented with ST-segment elevation myocardial infarction, 31 (34%) with non-ST-segment elevation myocardial infarction, 28 (31%) with unstable angina pectoris, and 2 (2%) with stable angina pectoris; 5 patients (6%) were studied for preoperative risk assessment. A total of 127 lesions were successfully treated using 102 drug-eluting stents and 37 bare-metal stents, with a mean of 1.5 stents per patient. Postprocedural complications included renal insufficiency in 5 patients (5.6%), heart failure in 6 patients (6.7%), and cardiogenic shock in 2 patients (2.2%). Seventy-seven patients (85.6%) experienced no postprocedural complications. In-hospital mortality was 7.8%, and actuarial survival was 61.5 ± 5.2% at 24 months and 31.6 ± 6.1% at 48 months. The SF-36 Health Survey was administered at follow-up, and results demonstrated a quality of life similar to that of the general population corrected for age and gender. In conclusion, this study demonstrates that percutaneous coronary intervention in nonagenarians can be accomplished with low mortality and morbidity and excellent midterm results. Moreover, functional improvement in nonagenarians supports enhanced quality of life comparable to that of the general population.

Primary Percutaneous Coronary Interventions in Nonagenarians

The optimal treatment of very elderly patients with ST elevation myocardial infarction (STEMI) is not yet defined. The aim of this study is to present the feasibility and safety of primary percutaneous coronary interventions (PCI) in nonagenarians. A retrospective analysis of all patients who underwent primary PCI due to STEMI between 2004 and 2008 was performed. Patients age 90 years or older at the time of the procedure were identified and studied. Twenty-two patients fulfilled the study criteria (median age 92 years; range, 90-97 years; 50% women). The procedural success rate was 82%. Bare metal stent implantation was performed in 82% of the procedures, whereas only balloon angioplasty was performed on the rest of them. One patient experienced a minor bleeding complication. Procedural mortality was 9% (2 out of 22 patients), and it was due to "no flow" phenomenon in both patients. In-hospital mortality was 27% (6/22 patients) and 30-day mortality was 32% (7/22 patients). All 3 patients with Killip class III-IV on admission died within 30 days compared with 4 of the 19 patients with Killip class I-II (P = 0.023). Furthermore, of 11 patients with anterior infarction, 7 died within 30 days compared with none of the 11 patients with infarction of other location (P = 0.004). Although primary PCI is feasible in patients 90 years or older suffering from STEMI, the short-term mortality rate is high especially in patients with anterior infarct location and/or severely depressed myocardial function.

Percutaneous Coronary Interventions in Nonagenarians: In‐Hospital Mortality and Outcome at One Year Follow‐up

Limited information is available regarding outcome of very elderly patients referred for percutaneous coronary intervention (PCI). This study aimed to assess acute and intermediate term clinical outcomes among nonagenarians. The study included 32 consecutive nonagenarian patients undergoing PCI between January 2001 to August 2006. There were 6 (19%) patients admitted with acute ST-segment elevation myocardial infarction (STEMI), 10 (31%) patients with non-STEMI, and 16 (50%) patients with unstable angina pectoris. Receiver-operator characteristic curve (ROC) analysis was done to define the relationship between heart rate, blood pressure, left ventricle ejection fraction, serum creatinine level, and mortality. Results: Immediate procedure success was achieved in 28 (88%) patients. Cumulative mortality at hospital discharge was 3(9%), at 6 months it was 6 (19%) and remained 6(19%) at 1 year follow-up. Hypotension and low ejection fraction correlated with in-hospital mortality and worst clinical outcome. Procedural success does not appear to decline in nonagenarians.

Carotid Stenting in the Elderly

Elderly patients are at higher risk of procedural complications. Surgical revascularization has been performed successfully in selected octogenarians.1,2 Nevertheless, it is widely believed that percutaneous approaches are safer in the elderly. Indeed, percutaneous coronary intervention is now successfully being performed even in selected nonagenarians.3 Thus, it is tempting to presume that carotid revascularization in the elderly might be safer if done via endovascular means (Figure).4 Figure. Angiography before (A) and after (B) a right carotid artery stent in an 81-year-old man with amaurosis fugax. Article see p 2343 The data to date, however, have been conflicting, with several reports demonstrating very high rates of stroke or death with carotid stenting in octogenarians. Furthermore, although carotid stenting with embolic protection has been shown to be noninferior to carotid endarterectomy in patients at high surgical risk, whether carotid stenting is equivalent to carotid endarterectomy remains an open question in patients at low surgical risk.5–7 Additionally, especially for asymptomatic patients, the question arises whether a patient will live long enough to derive potential benefit from any procedure. This question becomes more pressing as the elderly population expands and the definition of elderly creeps upward, and also as clinical trials continue to underenroll the elderly. The cut point where appropriate clinical caution turns instead into preconceived notions and age-related bias is difficult to define. In this issue of Circulation , Chiam et al report on 142 consecutive patients aged 80 years or older who underwent carotid stenting.8 This series of patients has previously been reported, with the current article adding observations related to intermediate-term …

Percutaneous coronary intervention in nonagenarians: Age before beauty?

Percutaneous coronary intervention in nonagenarians: Age before beauty?