The Journal of invasive cardiology · 2011
30-day outcome after percutaneous coronary angioplasty in nonagenarians: feasibility and specific considerations in different clinical settings.
Сравнительное исследованиеСтатьяНазвание и аннотация: Перевод пока не подготовлен
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Hendler Alberto, Katz Mark, Gurevich Yoseph, Reicher Meir, Blatt Alex, Gabara Zyad, Zyssman Itzhak, Vered Zvi, Krakover Ricardo
Аннотация
BACKGROUND: Nonagenarians have been systematically excluded from randomized trials dealing with invasive coronary strategies, resulting in a lack of evidence-based guidelines regarding the optimal approach in this population.
AIM: To describe the clinical and procedural characteristics and outcomes of patients 90 years of age or older who were treated with percutaneous coronary interventions (PCI).
METHODS: We evaluated the 30-day outcomes of patients 90 years or older who underwent PCI at our institution, comparing the ST-segment elevation myocardial infarction (STEMI) subgroup with the non-STEMI/unstable angina (UA) and stable angina (SA) subgroups, who had been referred for coronary angiography.
RESULTS: Over the time period 2002-2011, we identified 45 nonagenarians (mean age, 93 years; range, 90-102 years). The majority (59%) presented with an acute coronary syndrome and underwent immediate coronary revascularization by PCI. Technical success rate was 90%. The frequency of in-hospital death, need for urgent coronary artery bypass surgery, periprocedural cerebrovascular accident, and major adverse cardiovascular and cerebral events was 11%, 4.5%, 4.5%, and 18%, respectively. At 30 days, mortality was exclusively related to the STEMI subgroup with hemodynamic instability, compared with the non STEMI/UA and SA population.
CONCLUSIONS: In carefully selected nonagenarians, PCI in contemporary practice may be performed with a high technical success rate with relatively low morbidity and mortality. Questions are raised about the feasibility and outcome of invasive coronary strategies in the high-risk clinical subgroup of STEMI and hemodynamic instability.
AIM: To describe the clinical and procedural characteristics and outcomes of patients 90 years of age or older who were treated with percutaneous coronary interventions (PCI).
METHODS: We evaluated the 30-day outcomes of patients 90 years or older who underwent PCI at our institution, comparing the ST-segment elevation myocardial infarction (STEMI) subgroup with the non-STEMI/unstable angina (UA) and stable angina (SA) subgroups, who had been referred for coronary angiography.
RESULTS: Over the time period 2002-2011, we identified 45 nonagenarians (mean age, 93 years; range, 90-102 years). The majority (59%) presented with an acute coronary syndrome and underwent immediate coronary revascularization by PCI. Technical success rate was 90%. The frequency of in-hospital death, need for urgent coronary artery bypass surgery, periprocedural cerebrovascular accident, and major adverse cardiovascular and cerebral events was 11%, 4.5%, 4.5%, and 18%, respectively. At 30 days, mortality was exclusively related to the STEMI subgroup with hemodynamic instability, compared with the non STEMI/UA and SA population.
CONCLUSIONS: In carefully selected nonagenarians, PCI in contemporary practice may be performed with a high technical success rate with relatively low morbidity and mortality. Questions are raised about the feasibility and outcome of invasive coronary strategies in the high-risk clinical subgroup of STEMI and hemodynamic instability.