CHICAGO — The benefits of a strategy of primary percutaneous coronary intervention for ST-elevation MI in octogenarians are called into question by the latest data from the American College of Cardiology's National Cardiovascular Data Registry, Dr. Jeptha P. Curtis reported at the annual scientific sessions of the American Heart Association.
Patients aged 80 and older who underwent primary PCI had nearly a fourfold greater in-hospital mortality than did those younger than 80. They also had substantially higher rates of serious nonfatal complications, according to Dr. Curtis of Yale University, New Haven, Conn. (See box.)
A likely major contributor to the high mortality was the fact that octogenarians were at 37% greater relative risk of not receiving complete revascularization of the infarct-related artery, either because their coronary anatomy wasn't amenable to PCI or the procedure didn't achieve full Thrombolysis in Myocardial Infarction (TIMI)-3 grade flow, he added.
He reported on all patients with ST-elevation MI in the ACC national registry who underwent emergency catheterization during 2005, excluding those who underwent hospital transfer, received fibrinolytic therapy, or had a history of coronary artery bypass surgery. Of the19,229 eligible patients, 10% were aged 80 or older.
Octogenarians were more likely than younger patients to present with triple-vessel or left main disease, cardiogenic shock, or heart failure. They were less likely to undergo primary PCI (margin of 84%–87%).
Among patients with primary PCI, octogenarians were less likely to achieve postprocedural TIMI-3 flow, at 93% compared with 97% in younger patients.
Further studies of primary PCI in the elderly are needed, Dr. Curtis added.
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