PCI Feasible Even in Very Elderly Patients

Percutaneous coronary intervention (PCI) can be safely and successfully performed in patients 90 years of age or older presenting with ST-segment elevation myocardial infarction (STEMI), according to a new study.

Researchers at Pitie-Salpetriere Hospital (Paris, France), Sheba Medical Center (Tel Hashomer, Israel), and other institutions conducted a retrospective study of 145 consecutive all-comer nonagenarians treated with primary PCI for STEMI in five international high-volume centers between 2006 and 2013, in order to assess clinical events and mortality outcomes, which were assessed at six months and one year after the procedure.

The results showed that failed PCI occurred in 11% of patients due to distal embolization, coronary dissection, or inability to pass the wire through the thrombus. Overall, 60% of the procedures were performed through the transradial approach, with successful revascularization of the culprit vessel obtained in 86% of the cases. Major or clinically relevant bleeding was observed in 4% of patients, and in-hospital mortality was 24%. The six-month and one year survival rates were 61% and 53%, respectively. The study was published on July 13, 2016, in Heart.

“Despite intensive antiplatelet and anticoagulant therapy, major or clinically relevant bleeding events were recorded in only six patients during in-hospital follow-up,” concluded lead author Gérard Helft, MD, PhD, of Pitie-Salpetriere Hospital, and colleagues. “The high rate of procedures conducted through the transradial approach may explain the low rate of access site bleeding complications.”

STEMI, a more precise term for heart attack, is caused by a prolonged period of ischemia that affects large areas of the heart. It refers to an identifiable pattern as seen on an electrocardiogram (ECG). Thousands of patients with STEMI fail to receive critical therapy in a timely fashion, and nearly 30% of patients with STEMI do not receive reperfusion treatment at all.

Related Links:
Pitie-Salpetriere Hospital
Sheba Medical Center