Primary PCI for STEMI in Nonagenarians
What are the outcomes following primary percutaneous coronary intervention (PCI) for ST-segment elevation acute myocardial infarction (STEMI) in nonagenarian patients (ages ≥90 years)?
The investigators conducted a multicenter retrospective study between 2006 and 2013 in five international high-volume centers and included consecutive all-comer nonagenarians treated with primary PCI for STEMI. There were no exclusion criteria. They enrolled 145 patients and collected demographic, clinical, and procedural data. Severe clinical events and mortality at 6 months and 1 year were assessed. The log-rank test was used to compute the significance of time-to-event data, and survival rates were estimated using the Kaplan-Meier method.
Cardiogenic shock was present at admission in 21%. Median (interquartile range) delay between symptom onset and balloon was 3.7 (2.4-5.6) hours and 60% of procedures were performed through the transradial approach. Successful revascularization of the culprit vessel was obtained in 86% of the cases (Thrombolysis in Myocardial Infarction [TIMI] flow of 2 or 3). Major or clinically relevant bleeding was observed in 4% of patients. Median left ventricular ejection fraction post-PCI was 41.5% (32.0-50.0). The in-hospital mortality was 24%, with 6-month and 1-year survival rates of 61% and 53%, respectively.
The authors concluded that primary PCI in nonagenarians with STEMI was achieved and feasible.
This study reports that primary PCI can be safely and successfully performed in nonagenarians presenting with STEMI through a transradial approach. Similar to younger patients, this invasive strategy is associated with a high rate of achieved reperfusion of the infarct-related artery and low incidence of procedure-related complications in this specific population. While these results suggest that primary PCI may be offered to selected nonagenarians with acute MI, it should be noted that there was no comparison group, such as nonagenarians with STEMI who were not managed with primary PCI, so outcomes cannot be directly compared with optimal medical therapy. Further comparative clinical studies may help to better define the benefits and risk ratio of primary PCI in nonagenarians with STEMI.
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