Primary Percutaneous Coronary Interventions in Nonagenarians

Koutouzis, Michael; Grip, Lars; Matejka, Göran; Albertsson, Per

doi:10.1002/clc.20720

Cited by 17 publications

(11 citation statements)

References 20 publications

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“…This is similar to the outcomes of PCI in octogenarians in the ACC-NCDR, where the mortality rate was nearly 14% in those who presented with an acute MI within 24 hours, and less than the 27% observed in-hospital mortality in nonagenarians in a retrospective analysis. 15,28 Despite the high mortality rate observed in this patient group, it is much less than those patients treated medically for STEMI or cardiogenic shock. 29 Although in our registry, the STEMI and cardiogenic shock populations had the highest rate of mortality and other procedure-related complications, we feel that this risk is appropriate given the morbidity and mortality associated with medical therapy alone.…”

Section: Discussionmentioning

confidence: 94%

Outcome of Contemporary Percutaneous Coronary Intervention in the Elderly and the Very Elderly: Insights From the Blue Cross Blue Shield of Michigan Cardiovascular Consortium

Thomas

Moscucci

Smith

et al. 2011

Clinical Cardiology

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Background: There is a paucity of data on the outcome of contemporary percutaneous coronary intervention (PCI) in the elderly. Accordingly, we assessed the impact of age on outcome of a large cohort of patients undergoing PCI in a regional collaborative registry. Hypothesis: Increasing age is associated with a higher incidence of procedural-related complications. Results: Of the cohort, 64.64% were <70 years of age, 23.83% were 70 to 79 years, 7.85% were 80 to 84 years, 3.09% were 85 to 89 years, and 0.58% were 90 years or older. Increasing age was associated with an increase in all-cause in-hospital mortality, contrast-induced nephropathy, transfusion, stroke/transient ischemic attack, and vascular complications. The overall in-hospital mortality rate was 1.09% and increased from 0.67% in those younger than 70 years up to 5.44% in those 90 years old or greater. The mortality rate in patients over 80 years approached 12% to 15% for those with ST-segment myocardial infarction and 39% in cardiogenic shock patients. Conclusions: The proportion of elderly patients referred for PCI is increasing. Procedural complications increase with age, and patients presenting with unstable symptoms are at the highest risk.

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Section: Discussionmentioning

confidence: 94%

Outcome of Contemporary Percutaneous Coronary Intervention in the Elderly and the Very Elderly: Insights From the Blue Cross Blue Shield of Michigan Cardiovascular Consortium

Thomas

Moscucci

Smith

et al. 2011

Clinical Cardiology

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“…Previous multivariate logistic regression analyses in the literature revealed independent risk factors of in-hospital death for very old patients: cardiogenic shock, myocardial infarction without shock, left ventricular ejection fraction < 35%, renal insufficiency, age > 85 years and diabetes mellitus [10],[17],[21],[22]. As approximately 85% of the nonagenarians in our series had one or more indicators of clinical instability or worse prognosis (acute MI, cardiogenic shock, diabetes), we found an in-hospital mortality rate of 13%.…”

Section: Discussionmentioning

confidence: 99%

Cardiac catheterisation in nonagenarians: Single center experience

Ohlow

Hassan²,

Lotze³

et al. 2012

Journal of Geriatric Cardiology

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ObjectiveTo explore the treatment, procedure related risks, and outcomes of patients older than 90 years of age undergoing cardiac catheterization.MethodsWe retrospectively studied 32 patients ≥ 90 years (93.0 ± 1.2 years) who underwent cardiac catheterisation in a tertiary specialist hospital (0.2% of 14,892 procedures during three years). The results were compared to a patient cohort younger than 90 years of age.ResultsBaseline characteristics revealed a higher prevalence of diabetes (P < 0.001), chronic obstructive pulmonary disease (P < 0.04), previous myocardial infarction (P < 0.02), and complex coronary anatomy (SYNTAX score 33 vs. 19) in nonagenarians. Patients < 90 years of age showed more hyperlipidemia (P < 0.01) and previous percutaneous coronary interventions (P < 0.015). Nonagenarians underwent coronary angiography more often for acute coronary syndrome (ACS) (P < 0.003), were presented more often in cardiogenic shock (P < 0.003), and were transferred faster to coronary angiography in cases of ACS (P < 0.0001). The observed in-hospital mortality rate (13% study group vs. 1% control group; P < 0.003) in nonagenarians was lower than the calculated rate of thrombolysis in myocardial infarction (TIMI) and global registry of acute cardiac events (GRACE) mortality and strongly influenced by the severity of clinical presentation and the presence of co-morbidities.ConclusionDespite the common scepticism that cardiac catheterisation exposes patients ≥ 90 years to an unwarranted risk, our data demonstrate an acceptable incidence of complications and mortality in this group of patients.

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“…[25][26][27][28][29] Several studies demonstrated a continuous, curvilinear manner of mortality after elective coronary angiography and/or coronary intervention with increasing age, ranging from about 0.5% for patients < 55 years old to about 5% for patients > 85 years old. 7) This difference may be even more pronounced in the setting of acute coronary syndrome.…”

Section: )mentioning

confidence: 99%

Comorbidities and Complications in Nonagenarians Undergoing Coronary Angiography and Intervention

et al. 2017

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SummaryElderly people represent the fastest growing portion of cardiovascular patients. We aimed to analyze the clinical presentation, risk factors, co-morbidities, complications, and mortality in patients 90 years or more who underwent coronary angiography and intervention.We retrospectively studied 108 (0.25% of 43,385) consecutive patients ≥ 90 years undergoing cardiac catheterization and/or intervention in a tertiary specialist hospital between 2003 and 2014.Most patients (68.5%) were introduced on an emergency basis, especially with acute coronary syndrome (ACS) (63.8%). Non-STEMI accounted for two-thirds of the myocardial infarctions. We found higher prevalences of previous coronary artery disease (CAD) (38%), other atherosclerotic diseases (20.4%), cardiac risk factors such as hypertension (84.3%), diabetes (49.1%), hyperlipidemia (50.9%), heart failure (42.6%), atrial fibrillation (AF) (25.0%), severe aortic stenosis (13.0%), severe mitral regurgitation (3.7%), and implantable devices (25.0%), and co-morbidities such as renal impairment (48.1%), COPD (12.0%), and previous stroke (6.5%). Three-vessel disease was present in 34.6% of the patients. The left anterior descending artery (LAD) was the most affected coronary artery (67.6%). Percutaneous coronary intervention (PCI), mostly with bare metal stents (BMS), was used to manage 54.6% of the patients, and it failed in 4 of the patients. Conservative treatment was used in 39.8% of the patients and 15.7% had no significant CAD.The incidences of vascular complications, such as bleeding (6.5%), bleeding in other organs (6.5%), blood transfusion (6.5%), in-hospital paroxysmal atrial fibrillation (7.4%), in-hospital successful reanimation (2.8%), complete heart block (5.6%), acute renal impairment (23.1%), associated infection (25.9%), cardiogenic shock (14.8%), and death (15.7%) were high.Considering the more extensive risk factors, CAD and co-morbidities, acute presentation and age per se, we believe that the reported higher rates of complications and mortality are still acceptable. (Int Heart J 2017; 58: 180-184)

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Primary Percutaneous Coronary Interventions in Nonagenarians

Cited by 17 publications

References 20 publications

Outcome of Contemporary Percutaneous Coronary Intervention in the Elderly and the Very Elderly: Insights From the Blue Cross Blue Shield of Michigan Cardiovascular Consortium

Outcome of Contemporary Percutaneous Coronary Intervention in the Elderly and the Very Elderly: Insights From the Blue Cross Blue Shield of Michigan Cardiovascular Consortium

Cardiac catheterisation in nonagenarians: Single center experience

Comorbidities and Complications in Nonagenarians Undergoing Coronary Angiography and Intervention

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