title: 30-day outcome after percutaneous coronary angioplasty in nonagenarians: feasibility and specific considerations in different clinical settings.
abstract: BACKGROUND
  Nonagenarians have been systematically excluded from randomized trials dealing with invasive coronary strategies, resulting in a lack of evidence-based guidelines regarding the optimal approach in this population.
  
  
  OBJECTIVE
  To describe the clinical and procedural characteristics and outcomes of patients 90 years of age or older who were treated with percutaneous coronary interventions (PCI).
  
  
  METHODS
  We evaluated the 30-day outcomes of patients 90 years or older who underwent PCI at our institution, comparing the ST-segment elevation myocardial infarction (STEMI) subgroup with the non-STEMI/unstable angina (UA) and stable angina (SA) subgroups, who had been referred for coronary angiography.
  
  
  RESULTS
  Over the time period 2002-2011, we identified 45 nonagenarians (mean age, 93 years; range, 90-102 years). The majority (59%) presented with an acute coronary syndrome and underwent immediate coronary revascularization by PCI. Technical success rate was 90%. The frequency of in-hospital death, need for urgent coronary artery bypass surgery, periprocedural cerebrovascular accident, and major adverse cardiovascular and cerebral events was 11%, 4.5%, 4.5%, and 18%, respectively. At 30 days, mortality was exclusively related to the STEMI subgroup with hemodynamic instability, compared with the non STEMI/UA and SA population.
  
  
  CONCLUSIONS
  In carefully selected nonagenarians, PCI in contemporary practice may be performed with a high technical success rate with relatively low morbidity and mortality. Questions are raised about the feasibility and outcome of invasive coronary strategies in the high-risk clinical subgroup of STEMI and hemodynamic instability.
authors.affiliation: Assaf Harofeh Medical Center, Cardiology Division, Zerifin, Israel. ahendler@asaf.health.gov.il
authors.forename: Alberto
authors.initials: A
authors.lastname: Hendler
authors.forename: Mark
authors.initials: M
authors.lastname: Katz
authors.forename: Yoseph
authors.initials: Y
authors.lastname: Gurevich
authors.forename: Meir
authors.initials: M
authors.lastname: Reicher
authors.forename: Alex
authors.initials: A
authors.lastname: Blatt
authors.forename: Zyad
authors.initials: Z
authors.lastname: Gabara
authors.forename: Itzhak
authors.initials: I
authors.lastname: Zyssman
authors.forename: Zvi
authors.initials: Z
authors.lastname: Vered
authors.forename: Ricardo
authors.initials: R
authors.lastname: Krakover
mesh_terms: D000367:Age Factors; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome