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Primary percutaneous coronary intervention for ST elevation myocardial infarction in nonagenarians
  1. Thibaut Petroni1,
  2. Azfar Zaman2,
  3. Jean-Louis Georges3,
  4. Nadjib Hammoudi1,
  5. Emmanuel Berman1,
  6. Amit Segev4,
  7. Jean-Michel Juliard5,
  8. Olivier Barthelemy1,
  9. Johanne Silvain1,
  10. Rémi Choussat1,
  11. Claude Le Feuvre1,
  12. Gérard Helft1
  1. 1Cardiology Institute, Pitié-Salpêtrière Hospital, UPMC, APHP, Paris, France
  2. 2Freeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle Upon Tyne, UK
  3. 3Centre Hospitalier de Versailles, André Mignot Hospital, Le Chesnay, France
  4. 4Heart Institute, Chaim Sheba Medical Center, Tel-Hashomer, Israël
  5. 5Bichat Hospital, APHP, Paris, France
  1. Correspondence to Professor Gérard Helft, Cardiology Institute, Pitié-Salpêtrière Hospital, 47-83, boulevard de l'hôpital, Paris 75013, France; gerard.helft{at}psl.aphp.fr

Abstract

Objective To assess outcomes following primary percutaneous coronary intervention (PCI) for ST-segment elevation acute myocardial infarction (STEMI) in nonagenarian patients.

Methods We conducted a multicentre retrospective study between 2006 and 2013 in five international high-volume centres and included consecutive all-comer nonagenarians treated with primary PCI for STEMI. There were no exclusion criteria. We enrolled 145 patients and collected demographic, clinical and procedural data. Severe clinical events and mortality at 6 months and 1 year were assessed.

Results Cardiogenic shock was present at admission in 21%. Median (IQR) delay between symptom onset and balloon was 3.7 (2.4–5.6) hours and 60% of procedures were performed through the transradial approach. Successful revascularisation of the culprit vessel was obtained in 86% of the cases (thrombolysis in myocardial infarction flow of 2 or 3). Major or clinically relevant bleeding was observed in 4% of patients. Median left ventricular ejection fraction post PCI was 41.5% (32.0–50.0). The in-hospital mortality was 24%, with 6 months and 1-year survival rates of 61% and 53%, respectively.

Conclusions In our study, primary PCI in nonagenarians with STEMI was achieved and feasible through a transradial approach. It is associated with a high rate of reperfusion of the infarct-related artery and 53% survival at 1 year. These results suggest that primary PCI may be offered in selected nonagenarians with acute myocardial infarction.

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