Retrospective multicenter observational study of the interventional management of coronary disease in the very elderly: The NINETY

Authors


  • Conflict of interest: Nothing to report.

Correspondence to: Imad Sheiban, MD, Interventional Cardiology, Division of Cardiology, University of Turin, S. Giovanni Battista “Molinette” Hospital, Corso Bramante 88-90, 10126 Turin, Italy. E-mail: isheiban@yahoo.com

Abstract

Objectives

The aim of this observational, multicenter study was to describe the outcome of very elderly patients undergoing percutaneous coronary intervention (PCI).

Background

There is a paucity of data among nonagenarians undergoing PCI.

Methods

All consecutive patients 90 years of age or older undergoing PCI with stent implantation between April 2002 and June 2009 were included in the study. The primary endpoint was the long-term rate of net adverse cardiac events (NACE), that is, death, myocardial infarction (MI), target lesion revascularization, and life-threatening or major bleedings.

Results

One hundred forty-six nonagenarians were divided in three groups according to clinical setting: 27 (group A) stable angina or silent ischemia, 85 (group B) unstable angina or non-ST elevation MI, and 34 (group C) with ST elevation MI (STEMI). At 30 days, the incidence of NACE was significantly lower in patients in Group A vs. B or C (0% vs. 17.3% vs. 31.2%, P = 0.006), and the frequency of definite stent thrombosis was higher in Group C vs. A or B (9.4% vs. 0% vs. 0%, P = 0.007), respectively. Up to a median follow-up of 24 months, NACE rate was 33.3% in group A, 49.3% in group B, and 50% in group C (P = 0.32). There were no significant differences between groups in the individual components of the primary endpoint.

Conclusions

PCI in nonagenarians is safe and feasible with acceptable major bleeding rates. However, long-term results show high mortality rates particularly in the STEMI group. © 2013 Wiley Periodicals, Inc.

Ancillary