Impact of bivalirudin use on outcomes in nonagenarians undergoing percutaneous coronary intervention.
BACKGROUND
With an aging population, nonagenarians constitute an increasing percentage of patients with coronary artery disease. The aim of this study was to determine the predictors and outcome of nonagenarians undergoing percutaneous coronary intervention (PCI) for symptomatic coronary artery disease.


METHODS
From 2002 to 2007, a cohort of 171 consecutive nonagenarians underwent PCI and stent implantation in our center. Patients given bivalirudin (n = 79) during the procedure were compared to those given heparin (n = 92). In-hospital and 6-month rates of major adverse cardiovascular events (MACE) including death, myocardial infarction (MI), and target lesion revascularization were indexed. In-hospital bleedings were also indexed.


RESULTS
The mean age was 92.5 +/- 2.5 years. The population was 52% female. Nearly 30% of patients had diabetes mellitus and >25% had renal failure. The mean left ventricular ejection fraction was 45%+/- 14%. The clinical presentation was an acute MI in 59% of the cases. The in-hospital rates of death and bleedings were 4.1% and 17.5%, respectively. Clinical presentations as MI or cardiogenic shock were associated with high rates of in-hospital death: 19.3% and 30%, respectively. Bivalirudin use was associated with a 41.5% decrease in in-hospital bleedings. The 6-month incidence of MACE was 13.6% and was driven by death. Predictors of 6-month outcomes were clinical presentations as MI or cardiogenic shock, renal failure, and total stent length.


CONCLUSIONS
Nonagenarians represent a particular population with a high percentage of females and a high incidence of comorbidities. In this study, we highlighted that nonagenarians have logically a worse prognosis than is reported in younger patients, with especially high rates of in-hospital bleedings. Bivalirudin use was associated with an important decrease in in-hospital bleedings; thus, it should be systematically considered in such patients to improve early outcome.
Lemesle
Gilles
G
Department of Internal Medicine, Division of Cardiology, Washington Hospital Center, Washington, DC 20010, USA.
Bonello
Laurent
L
De Labriolle
Axel
A
Steinberg
Daniel H
DH
Roy
Probal
P
Slottow
Tina L Pinto
TL
Torguson
Rebecca
R
Kaneshige
Kimberly
K
Xue
Zhenyi
Z
Suddath
William O
WO
Satler
Lowell F
LF
Kent
Kenneth M
KM
Lindsay
Joseph
J
Pichard
Augusto D
AD
Waksman
Ron
R
D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D015331:Cohort Studies; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000188:drug therapy* / Q000453:epidemiology / Q000628:therapy; D005260:Female; D006493:Heparin / Q000627:therapeutic use; D006629:Hirudins; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D010446:Peptide Fragments / Q000627:therapeutic use*; D016016:Proportional Hazards Models; D011994:Recombinant Proteins / Q000627:therapeutic use; D015607:Stents; D016896:Treatment Outcome
D000925:Anticoagulants; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; D006493:Heparin; C074619:bivalirudin