title: Percutaneous coronary intervention in nonagenarian: a meta-analysis of observational studies.
abstract: BACKGROUND
  Developed countries are facing a sustained increase in life expectancy. Along with all social and cultural implications of increase lifespan, very elderly patients are undergoing percutaneous coronary intervention (PCI) with increasing frequency. However, there is limited evidence to guide clinicians in evaluating pros and cons of PCI in this very frail patient population. We, thus, aimed to perform a systematic review and meta-analysis of clinical studies reporting on PCI with stenting in nonagenarians.
  
  
  METHODS
  Studies reporting on five or more nonagenarians undergoing PCI were systematically searched in PubMed (last updated on November 2011). Baseline and clinical characteristics, in-hospital and long-term outcomes were systematically appraised. End points of interest were in-hospital and long-term follow-up incidence of death and Major Adverse Cardiac Events (MACE; i.e. the composite of death from all causes, myocardial infarction or repeat revascularization). Events were pooled with a random-effect model, generating summary estimates of incidence rates [95% confidence intervals (CI)].
  
  
  RESULTS
  A total of 10 studies were included, reporting on a total of 575 nonagenarians undergoing PCI with stenting who represented 1.99% (1.34-2.5) of those undergoing revascularization in the cath lab in a mean period of 5 (3-7) years. Twenty-three percent (13-45) of patients presented with STEMI (ST Segment Elevation Myocardial Infarction), 10% (7-12) with cardiogenic shock and in 78% (64-88) of cases a multivessel disease was diagnosed. Meta-analytic pooling of event rates showed an in-hospital death risk of 12.61% (9.71-15.50) with MACE in 16.41% (13.36-19.47). After a follow-up ranging from 6 to 29 months (median 12), the risk of long-term death was 31.00% (17.10-45.52), with MACE in 37.00% (19.56-55.95; all CI 95%).
  
  
  CONCLUSIONS
  Our meta-analysis, pooling the largest cohort ever of nonagenarians undergoing PCI with stents, confirms the feasibility of percutaneous coronary stenting even in this very frail patient subset, despite the expected severe event attrition during follow-up. Thus, nonagenarians with an acceptable risk profile, recent clinical instability and/or disabling symptoms should not be denied the possibility of percutaneous coronary revascularization.
authors.affiliation: aDivision of Cardiology, Department of Internal Medicine, Turin, Italy bDepartment of Cardiology, St.Joseph's Regional Medical Center, Paterson, New Jersey cDivision of Cardiology, David Geffen School of Medicine, University of California, Los Angeles, California, USA dDivision of Interventional Cardiology, Instituto Cardiovascular, Hospital La Paz, Paseo La Castellana, Madrid, Spain eDepartment of Medico-Surgical Sciences, Biotechnologies Sapienza University of Rome, Italy fInvasive Cardiology, Campus Middelheim, Antwerpen, Belgium gMeta-analysis and Evidence based medicine Training in Cardiology, Italy.
authors.forename: Davide G
authors.initials: DG
authors.lastname: Presutti
authors.forename: Fabrizio
authors.initials: F
authors.lastname: D'Ascenzo
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Omedè
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Biondi-Zoccai
authors.forename: Claudio
authors.initials: C
authors.lastname: Moretti
authors.forename: Mario
authors.initials: M
authors.lastname: Bollati
authors.forename: Filippo
authors.initials: F
authors.lastname: Sciuto
authors.forename: Michael S
authors.initials: MS
authors.lastname: Lee
authors.forename: Raul
authors.initials: R
authors.lastname: Moreno
authors.forename: Mahesh
authors.initials: M
authors.lastname: Bikkina
authors.forename: Marco
authors.initials: M
authors.lastname: Di Cuia
authors.forename: Chiara
authors.initials: C
authors.lastname: Resmini
authors.forename: Fiorenzo
authors.initials: F
authors.lastname: Gaita
authors.forename: Imad
authors.initials: I
authors.lastname: Sheiban
mesh_terms: D000369:Aged, 80 and over; D003327:Coronary Disease / Q000628:therapy*; D015577:Geriatric Assessment; D006801:Humans; D010043:Outcome and Process Assessment, Health Care; D062645:Percutaneous Coronary Intervention; D012307:Risk Factors