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Int J Cardiol. 2015 Aug 1;192:24-9. doi: 10.1016/j.ijcard.2015.04.227. Epub 2015 Apr 30.

Outcomes of primary percutaneous coronary interventions in nonagenarians with acute myocardial infarction.

Collaborators (294)

Bourkaib, Brénot, Herman, Guyon, Royer, Stratiev, Carradot, Boccara, Menguy, Bensalem, Rivoal, Touitou, Mme Rodriguez, Alayrac, Hellio, Nunes, Compagnon, Fossay, Grippon, Aubry, Poulos, Birlouez, Sebbah, Thevenin, Hakim, Desrues, Aubert, Clavie, Ducommun, Faggianelli, Schvahn, Coudray, Hautefeuille, Rousseau, Ta, Elhadad, Mathieu, Porcher, Stibbe, Echard, Meaux, Meaux, Bouvet, Goes, Limoges, Letarnec, Rebillard, Tazarourte, Amokrane, Cadot, Coletta, Demiere, D'Araujo, Roy, Tarlier, Chevrier, Clero, Lederlin, Georges, Livarek, Gibault-Genty, Blicq, Boutot, Lambert, Moro, Richard, Sammut, Jourdan, Benaicha, Gaffinel, Jeufraux, Nguyen, Pone, Delafontaine, Hennequin, Faivre, Goldman, Hazan, Pasquereau, Viso, Meyer, Bois, Montely, Biens, Charestan, Mezard, Raphaël, Benaceur, Guerout, Akesbi, Dormagen, Karrillon, Stratiev, Belotte, Lefevre, Monfroy, Peyron Fourcade, Berthier, Goube, Toussaint, Briole, Capitani, Desclefs, Laborne, Pouges, Roignant, Cabo, Lairy, Carreres, Cuvier, Chevalier, Dumant, Wyart, Auger, Bergeron, Meinadier, Tshisumbule, Casciani, Binda, Le Foll-Llanas, Rakotonirina, Cattan, Beruben, Cavagna, Kergueno, Hennion, Lesgourgues, Laye, Marchand, Getti, Lefevre, Ramaut, Ruiz, Lellouch, Razafimamonjy, Patte, Lancelin, Pagny, Herman, Pioger, Beverelli, Gérardin, Makowski, Bucquoit, Durand, Housni, Rousseau, Aptecar, Dupouy, Grandcoin, Sebagh, Gueyouche, Leminou, Morange, Brami, Sarfati, Gazi, Jacquemet, Benamer, Leclerc, Caussin, Vallet, Dambrin, Favereau, Baget, Debris, de Livron, El Mahmoud, Dubourg, Lot, Tarragano, Richard, Slama, Civadier, Lenoir, Adnet, Lapostolle, Devaud, Duchateau, Ricard-Hibon, Mantz, Juliard, Steg, Buzzi, Lê-leplat, Varenne, Weber, Dreau, Frenkiel, Barbou, Schiano, Romary, Funck, Gaillard, Boukacem, Dupas, Giroud, Decup, Benamer, Allouch, Lebovisci, Blanchard, Lafont, Spaulding, Heudes, Karafilovic, Chatellier, Champagne, Teiger, Aurore, Bertrand, Boche, Goldstein, Jacob, Ladka, Penet, Marty, Hemery, Boizat, Bourgeois, Eche, Kierzek, Sahakian, Pourriat, Manzo-Silberman, Azancot, Chaplain, Gueye, Payen, Brechat, Lebrun, Segouin, Greffet, Jaffry, Lamhaut, Carli, Barthélémy, Batisse, Choussat, Petroni, Silvain, Collet, Helft, Le Feuvre, Montalescot, Boon, Delay, Ecollan, Kergueno, Rufat, Baudelou, Antony, Pernes, Gedin, Parisien, Anconina, Osorovitz, Renouf, Baer, Cahun-Girand, Goddet, Lebail, Boccara, Bourquard, Brard, Cador, Gaillard, Rejasse, Michel, Lukacs, Garot, Servigne, Vollaire, Lefevre, Morice, Cohen-Attia, Gedin, Vollaire, Dibie, Monsegu, Slama, Gayer, Germain, Domanski, Jost, Tourtier, Courtiol, Ramdani, Violin, Ernouf, Lefort, Mlynski, Bon, Culoma.

Author information

1
Assistance Publique-Hôpitaux de Paris, Cardiology Department, Pitié-Salpétrière Hospital, Paris, France; Assistance Publique-Hôpitaux de Paris, ICAN, Pitié-Salpétrière Hospital, Paris, France; Pierre et Marie-Curie University, Paris, France. Electronic address: gerard.helft@psl.aphp.fr.
2
Versailles Hospital, Cardiology Department, Le Chesnay, France.
3
Regional Health Agency of the Greater Paris Area, Registry Department, Paris, France.
4
Assistance Publique-Hôpitaux de Paris, European Hospital Georges Pompidou, Cardiology Department, Paris, France; INSERM U970, Paris Cardiovascular Research Center-PARCC, Paris, France; Paris Descartes University, Paris, France.
5
Institut Mutualiste Montsouris, Cardiology Department, Paris, France.
6
Hôpital Européen de Paris - La Roseraie, Cardiology Department, Aubervilliers, France.
7
Institut Cardiovasculaire Paris Sud - Galien, Cardiology Department, Quincy sous Sénart, France.
8
Assistance Publique-Hôpitaux de Paris, Henri Mondor Hospital, Cardiology Department, Créteil, France.
9
Assistance Publique-Hôpitaux de Paris, Cochin Hospital, Cardiology Department, Paris, France.
10
Assistance Publique-Hôpitaux de Paris, Cardiology Department, Pitié-Salpétrière Hospital, Paris, France.
11
Versailles Hospital, SAMU 78, Le Chesnay, France.
12
Pontoise Hospital, SAMU 95, Pontoise, France.
13
Centre Hospitalier Sud Francilien, SAMU 91, Corbeil-Essonnes, France.
14
Assistance Publique-Hôpitaux de Paris, Avicenne Hospital, SAMU 93, Bobigny, France.
15
Fire Department of Paris, EMS Department, Paris, France.
16
Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Cardiology Department, Paris, France.
17
Melun Hospital, SAMU 77, Melun, France.
18
Assistance Publique-Hôpitaux de Paris, Necker Hospital, SAMU 75, Paris, France.
19
Assistance Publique-Hôpitaux de Paris, Raymond Poincaré Hospital, SAMU 92, Garches, France.
20
Assistance Publique-Hôpitaux de Paris, Henri Mondor Hospital, SAMU 94, Créteil, France.

Abstract

BACKGROUND:

Few data are available on primary percutaneous coronary intervention (pPCI) in nonagenarians. In a large prospective registry on pPCI for STEMI we compared the demographics, procedural and in-hospital outcomes between nonagenarians (age ≥ 90 years) and patients aged < 90 years.

METHODS AND RESULTS:

We included 26,157 consecutive patients with pPCI in the Greater Paris Area region between 2003 and 2011. Of these, 418 (1.6%) were ≥ 90 years old. Nonagenarians (versus patients < 90 years) were more likely to be female (62.3% versus 22.5%, p < 0.0001), nonsmokers (81.6% versus 36.7%, p < 0.0001), in cardiogenic shock (Killip IV) upon admission (10.5% versus 4.8%, p < 0.001), and had significant co-morbidities. Over two-thirds of patients underwent procedures via the radial artery (61% versus 72.1%, p = 0.007). Both groups had high and similar angiographic success rates (98.1% versus 98.7%, p = 0.33). Drug-eluting stents were used less often in nonagenarians (4.4% versus 16.7%, p < 0.0001). Hospital mortality was significantly much higher in patients over 90 years old (24.9% versus 5.1%, p < 0.001) in univariate analysis. After adjustment for sex, cardiogenic shock, diabetes, triple vessel disease, drug-eluting stent use and glycoprotein IIb/IIIa inhibitors use, mortality remains higher in nonagenarian patients (OR: 4.31; 95% CI: 3.26-5.71, p < 0.0001).

CONCLUSIONS:

In a real-world setting, we found important demographic differences in nonagenarian compared to younger patients. Despite achieving a high rate of reperfusion with pPCI using mainly radial access, similar to that achieved in younger patients, hospital mortality was higher in nonagenarians.

KEYWORDS:

Elderly; Myocardial infarction; Nonagenarian; Primary PCI

PMID:
25985011
DOI:
10.1016/j.ijcard.2015.04.227
[Indexed for MEDLINE]

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