Primary percutaneous coronary interventions in nonagenarians.
BACKGROUND
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.


METHODS
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.


RESULTS
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).


CONCLUSIONS
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.
Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden. michail.koutouzis@vgregion.se
Michael
M
Koutouzis
Lars
L
Grip
Göran
G
Matejka
Per
P
Albertsson
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000401:mortality / Q000706:statistics & numerical data; D005240:Feasibility Studies; D005260:Female; D006352:Heart Ventricles; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013548:Sweden; D016896:Treatment Outcome