[Use and limitations of invasive coronary strategy in nonagerians].
BACKGROUND
Nonagenarians 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.


OBJECTIVE
To evaluate the benefits and hazards of CA and PCI in nonagenarians.


METHODS
Retrospective study conducted from the database (Cardioreport(®)) of the CH de Versailles, from January 2001 to December 2011.


RESULTS
From 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%.


CONCLUSIONS
Angiography 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.
Service de cardiologie, hôpital André-Mignot, centre hospitalier de Versailles, 177, rue de Versailles, 78157 Le Chesnay cedex, France. Electronic address: jgeorges@ch-versailles.fr.
J-L
JL
Georges
B
B
Jerbi
G
G
Gibault-Genty
E
E
Blicq
R
R
Convers
H
H
Tawaba
E
E
Elbeainy
H
H
Soleille
J-P
JP
Aziza
B
B
Livarek
D054058:Acute Coronary Syndrome / Q000453:epidemiology / Q000628:therapy*; D000369:Aged, 80 and over; D017023:Coronary Angiography / Q000009:adverse effects / Q000379:methods; D005260:Female; D005263:Femoral Artery; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000453:epidemiology / Q000628:therapy; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects; D011654:Pulmonary Edema / Q000453:epidemiology; D017534:Radial Artery; D012189:Retrospective Studies
Angioplastie coronaire; Coronarographie; Coronary angiography; Elderly; Infarctus du myocarde; Myocardial infarction; Nonagerian; Nonagénaire; Percutaneous coronary intervention; Radial route; Voie radiale; Âge