title: Outcomes of primary percutaneous coronary interventions in nonagenarians with acute myocardial infarction.
abstract: BACKGROUND
  Few data are available on primary percutaneous coronary intervention (pPCI) in nonagenarians. In a large prospective registry on pPCI for STEMI we compared the demographics, procedural and in-hospital outcomes between nonagenarians (age ≥ 90 years) and patients aged < 90 years.
  
  
  RESULTS
  We included 26,157 consecutive patients with pPCI in the Greater Paris Area region between 2003 and 2011. Of these, 418 (1.6%) were ≥ 90 years old. Nonagenarians (versus patients < 90 years) were more likely to be female (62.3% versus 22.5%, p < 0.0001), nonsmokers (81.6% versus 36.7%, p < 0.0001), in cardiogenic shock (Killip IV) upon admission (10.5% versus 4.8%, p < 0.001), and had significant co-morbidities. Over two-thirds of patients underwent procedures via the radial artery (61% versus 72.1%, p = 0.007). Both groups had high and similar angiographic success rates (98.1% versus 98.7%, p = 0.33). Drug-eluting stents were used less often in nonagenarians (4.4% versus 16.7%, p < 0.0001). Hospital mortality was significantly much higher in patients over 90 years old (24.9% versus 5.1%, p < 0.001) in univariate analysis. After adjustment for sex, cardiogenic shock, diabetes, triple vessel disease, drug-eluting stent use and glycoprotein IIb/IIIa inhibitors use, mortality remains higher in nonagenarian patients (OR: 4.31; 95% CI: 3.26-5.71, p < 0.0001).
  
  
  CONCLUSIONS
  In a real-world setting, we found important demographic differences in nonagenarian compared to younger patients. Despite achieving a high rate of reperfusion with pPCI using mainly radial access, similar to that achieved in younger patients, hospital mortality was higher in nonagenarians.
authors.affiliation: Assistance Publique-Hôpitaux de Paris, Cardiology Department, Pitié-Salpétrière Hospital, Paris, France; Assistance Publique-Hôpitaux de Paris, ICAN, Pitié-Salpétrière Hospital, Paris, France; Pierre et Marie-Curie University, Paris, France. Electronic address: gerard.helft@psl.aphp.fr.
authors.forename: Gérard
authors.initials: G
authors.lastname: Helft
authors.affiliation: Versailles Hospital, Cardiology Department, Le Chesnay, France.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Georges
authors.affiliation: Regional Health Agency of the Greater Paris Area, Registry Department, Paris, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Mouranche
authors.affiliation: Regional Health Agency of the Greater Paris Area, Registry Department, Paris, France.
authors.forename: Aurélie
authors.initials: A
authors.lastname: Loyeau
authors.affiliation: Assistance Publique-Hôpitaux de Paris, European Hospital Georges Pompidou, Cardiology Department, Paris, France; INSERM U970, Paris Cardiovascular Research Center-PARCC, Paris, France; Paris Descartes University, Paris, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Spaulding
authors.affiliation: Institut Mutualiste Montsouris, Cardiology Department, Paris, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Caussin
authors.affiliation: Hôpital Européen de Paris - La Roseraie, Cardiology Department, Aubervilliers, France.
authors.forename: Hakim
authors.initials: H
authors.lastname: Benamer
authors.affiliation: Institut Cardiovasculaire Paris Sud - Galien, Cardiology Department, Quincy sous Sénart, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Garot
authors.affiliation: Versailles Hospital, Cardiology Department, Le Chesnay, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Livarek
authors.affiliation: Assistance Publique-Hôpitaux de Paris, Henri Mondor Hospital, Cardiology Department, Créteil, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Teiger
authors.affiliation: Assistance Publique-Hôpitaux de Paris, Cochin Hospital, Cardiology Department, Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Varenne
authors.affiliation: Institut Mutualiste Montsouris, Cardiology Department, Paris, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Monségu
authors.affiliation: Regional Health Agency of the Greater Paris Area, Registry Department, Paris, France.
authors.forename: Mireille
authors.initials: M
authors.lastname: Mapouata
authors.affiliation: Assistance Publique-Hôpitaux de Paris, Cardiology Department, Pitié-Salpétrière Hospital, Paris, France.
authors.forename: Thibaut
authors.initials: T
authors.lastname: Petroni
authors.affiliation: Assistance Publique-Hôpitaux de Paris, Cardiology Department, Pitié-Salpétrière Hospital, Paris, France.
authors.forename: Nadjib
authors.initials: N
authors.lastname: Hammoudi
authors.affiliation: Versailles Hospital, SAMU 78, Le Chesnay, France.
authors.forename: Yves
authors.initials: Y
authors.lastname: Lambert
authors.affiliation: Pontoise Hospital, SAMU 95, Pontoise, France.
authors.forename: François
authors.initials: F
authors.lastname: Dupas
authors.affiliation: Centre Hospitalier Sud Francilien, SAMU 91, Corbeil-Essonnes, France.
authors.forename: François
authors.initials: F
authors.lastname: Laborne
authors.affiliation: Assistance Publique-Hôpitaux de Paris, Avicenne Hospital, SAMU 93, Bobigny, France.
authors.forename: Frederic
authors.initials: F
authors.lastname: Lapostolle
authors.affiliation: Fire Department of Paris, EMS Department, Paris, France.
authors.forename: Hugues
authors.initials: H
authors.lastname: Lefort
authors.affiliation: Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Cardiology Department, Paris, France.
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Juliard
authors.affiliation: Melun Hospital, SAMU 77, Melun, France.
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Letarnec
authors.affiliation: Assistance Publique-Hôpitaux de Paris, Necker Hospital, SAMU 75, Paris, France.
authors.forename: Lionel
authors.initials: L
authors.lastname: Lamhaut
authors.affiliation: Assistance Publique-Hôpitaux de Paris, Raymond Poincaré Hospital, SAMU 92, Garches, France.
authors.forename: Gaëlle
authors.initials: G
authors.lastname: Lebail
authors.affiliation: Assistance Publique-Hôpitaux de Paris, Henri Mondor Hospital, SAMU 94, Créteil, France.
authors.forename: Thévy
authors.initials: T
authors.lastname: Boche
authors.affiliation: Assistance Publique-Hôpitaux de Paris, European Hospital Georges Pompidou, Cardiology Department, Paris, France; INSERM U970, Paris Cardiovascular Research Center-PARCC, Paris, France; Paris Descartes University, Paris, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Jouven
authors.affiliation: Regional Health Agency of the Greater Paris Area, Registry Department, Paris, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Bataille
mesh_terms: D000367:Age Factors; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D062645:Percutaneous Coronary Intervention; D012042:Registries; D016896:Treatment Outcome
keywords: Elderly; Myocardial infarction; Nonagenarian; Primary PCI