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Coron Artery Dis. 2009 Mar;20(2):118-23. doi: 10.1097/MCA.0b013e3283292ae1.

In-hospital outcomes of emergent and elective percutaneous coronary intervention in octogenarians.

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1
Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.

Abstract

OBJECTIVES:

Although the prevalence of coronary artery disease increases with age, elderly patients are underrepresented in clinical trials. We sought to describe the short-term outcomes of octogenarians undergoing percutaneous coronary intervention (PCI) in both emergent and elective settings.

METHODS:

We retrospectively identified all octogenarians undergoing PCI at our institution from January 2002 to December 2005. The outcomes of those undergoing primary PCI for ST-segment elevation myocardial infarction (group A) were compared with a randomly selected cohort of octogenarians undergoing elective PCI (group B).

RESULTS:

Group A comprised 91 patients and group B 88 patients. Procedure success was high with Thrombolysis in Myocardial Infarction grade 3 flow achieved in greater than 90% of patients in both groups. Group A experienced more postprocedure morbidity including acute renal failure (47 vs. 8%) and bleeding requiring transfusion (51 vs. 17%) (P<0.0001 for both comparisons). In-hospital mortality was higher in group A (21 vs. 0%). In multivariate analysis, the risk of in-hospital mortality was predicted by lower admission systolic blood pressure (odds ratio 1.026 per point decrease in systolic blood pressure; 95% confidence interval 1.003-1.049; P = 0.030) and development of cardiogenic shock (odds ratio 7.506; 95% confidence interval, 1.865-30.207; P = 0.005). Mortality in group A was significantly higher among patients with cardiogenic shock (42 vs. 6%, P<0.001).

CONCLUSION:

PCI is a safe and highly effective procedure in octogenarians during both emergent and elective settings. However, elderly patients undergoing primary angioplasty who develop hemodynamic instability during ST-segment elevation myocardial infarction remain at increased risk for mortality. Measures to reduce postprocedure bleeding and renal dysfunction may improve outcomes among elderly patients undergoing PCI.

PMID:
19293712
DOI:
10.1097/MCA.0b013e3283292ae1
[Indexed for MEDLINE]
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