Key result
Emergent primary PCI for STEMI in octogenarians was associated with higher in-hospital mortality and morbidity compared to elective PCI.
Why the study?
What are the in-hospital outcomes and complication rates of emergent primary PCI compared to elective PCI in octogenarians?
Cohort (n=179)
No
What are the in-hospital outcomes and complication rates of emergent primary PCI compared to elective PCI in octogenarians?
While PCI is highly effective in octogenarians, emergent primary PCI for STEMI carries a substantial risk of in-hospital mortality, bleeding, and renal failure, particularly in patients presenting with cardiogenic shock or lower systolic blood pressure.
Answers are grounded in this paper and cite their sources.
May inform risk discussions and selection for emergent PCI in octogenarians; leaves open optimal strategies pending randomized data.
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.
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Merchant et al. (2009) conducted a cohort in Coronary artery disease (STEMI and elective) (n=179). Emergent primary PCI for STEMI vs. Elective PCI was evaluated on In-hospital mortality. Emergent primary PCI for STEMI in octogenarians was associated with higher in-hospital mortality and morbidity compared to elective PCI.
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