Primary percutaneous coronary intervention in nonagenarians: is it worthwhile?

Primary percutaneous coronary intervention in nonagenarians: is it worthwhile?

Previous studies have demonstrated the feasibility of primary percutaneous coronary intervention (PPCI) in carefully selected nonagenarians. Although current guidelines recommend immediate revascularization in patients with ST elevation myocardial infarction (STEMI) it remains unclear whether PPCI r...

Full description

Saved in:
Bibliographic Details
Published in:BMC cardiovascular disorders Vol. 21; no. 1; p. 30
Main Authors: Meah, Mohammed M N, Joseph, Tobin, Ding, Wern Yew, Shaw, Matthew, Hasleton, Jonathan, Palmer, Nick D, Velavan, Periaswamy, Aggarwal, Suneil K
Format: Journal Article
Language:English
Published: England BioMed Central Ltd 13-01-2021
BioMed Central
BMC
Subjects:
Age
Aged
Angioplasty
Care and treatment
Demographic aspects
Feasibility studies
Fibrillation
Heart attack
Heart attacks
Mortality
Myocardial infarction
Nonagenarian
Patient outcomes
Patients
Population
Primary PCI
Statistical analysis
Survival
Transluminal angioplasty
United Kingdom
Myocardial infarction
Primary PCI
Nonagenarian
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Previous studies have demonstrated the feasibility of primary percutaneous coronary intervention (PPCI) in carefully selected nonagenarians. Although current guidelines recommend immediate revascularization in patients with ST elevation myocardial infarction (STEMI) it remains unclear whether PPCI reduces mortality in nonagenarians. The objective of this study is to compare mortality in nonagenarians presenting via the PPCI pathway who undergo coronary intervention, versus those who are managed medically. A total of 111 consecutive nonagenarians who presented to our tertiary center via the PPCI pathway between July 2013 and December 2018 with myocardial infarction were included. Clinical and angiographic details were collected alongside data on all-cause mortality. The final diagnosis was STEMI in 98 (88.3%) and NSTEMI in 13 (11.7%). PPCI was performed in 42 (37.8%), while 69 (62.2%) were medically managed. A significant number of the medically managed cohort had atrial fibrillation (23.2% vs 2.4% p = 0.003) and presented with a completed infarct (43.5% vs 4.8% p = 0.001). Other baseline and clinical variables were well matched in both groups. There was a trend towards increased 30-day mortality in the medically managed group (40.6% vs 23.8% p = 0.07). Kaplan Meier survival analysis demonstrated a significant difference in survival by 3 years (48.1% vs 21.7% p = 0.01). This was the case even when those with completed infarcts were excluded (44.3% vs 14.6%, p = 0.01). In this series of selected nonagenarians presenting with acute myocardial infarction, those undergoing PPCI appeared to have a lower mortality compared to those managed medically.
Bibliography:ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
content type line 23
ISSN:1471-2261
1471-2261
DOI:10.1186/s12872-020-01833-2