Primary percutaneous coronary intervention in nonagenarians: is it worthwhile?

Autor: Suneil Aggarwal, Mohammed Meah, Nicholas D. Palmer, Wern Yew Ding, Periaswamy Velavan, Matthew Shaw, Tobin Joseph, Jonathan Hasleton
Jazyk: angličtina
Rok vydání: 2021
Předmět:
Male
medicine.medical_specialty
lcsh:Diseases of the circulatory (Cardiovascular) system
Time Factors
medicine.medical_treatment
Clinical Decision-Making
Comorbidity
Coronary Artery Disease
030204 cardiovascular system & hematology
Revascularization
Risk Assessment
03 medical and health sciences
0302 clinical medicine
Percutaneous Coronary Intervention
Risk Factors
Internal medicine
medicine
Humans
030212 general & internal medicine
Myocardial infarction
Nonagenarian
Non-ST Elevated Myocardial Infarction
Survival analysis
Primary PCI
Angiology
Retrospective Studies
Aged
80 and over
business.industry
Age Factors
Percutaneous coronary intervention
Atrial fibrillation
Cardiovascular Agents
medicine.disease
Cardiac surgery
Treatment Outcome
lcsh:RC666-701
Cohort
Cardiology
ST Elevation Myocardial Infarction
Female
Cardiology and Cardiovascular Medicine
business
Research Article
Zdroj: BMC Cardiovascular Disorders, Vol 21, Iss 1, Pp 1-8 (2021)
BMC Cardiovascular Disorders
BMC CARDIOVASCULAR DISORDERS
ISSN: 1471-2261
Popis: Background 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. Methods and results 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). Conclusion 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.
Databáze: OpenAIRE
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