Introduction Primary PCI (PPCI) as management for acute STEMI is an established evidence based treatment offered across the UK. Evidence of benefit in the very elderly is sparse. With an aging population, the demand on primary PCI services for STEMI in the very elderly is likely to increase. Our aim was to establish real life outcome in a large sample of patients aged 85 years and over who received PPCI for acute STEMI.
Methods Data was collected retrospectively on all patients aged 85 years and over who were referred and accepted for PCI at our centre between the years of 2013 and 2018 inclusive. Data on patient demographics, characteristics, door-to-balloon time, left ventricular function and mortality was extracted.
Results 172 patients aged 85 and over were referred and accepted for STEMI treatment with PPCI at our regional Coronary Catheterisation Laboratory over the 6 year period. This represented 4.8% of all referrals over this time. The oldest patient was 99 years old. The absolute number of cases per year did not show an upward trend over the 6 year study period. 164 individuals went on to have emergency diagnostic coronary angiogram, of which 143 cases proceeded to PCI. PCI was successful in >95% of cases with a median door-to-balloon time was 26:00 minutes. 36% of all patients post-MI had moderate or severe LVSD on echocardiogram. Table 1 illustrates the demographics and findings of our study.
Median hospital stay for all patients was 7 days (range 1 – 190). 131 of 164 survived to discharge (79.9%). 94.6% of these patients were discharged to their own home, and 5.4 % were discharged to a nursing home. Median survival of all patients who were discharged was 1.8 years. 55% (n=72) of discharged patients were deemed functionally independent. When compared to those who mobilised with assistance, functionally independent patients had similar survival rates at 30 days (98.6% v 96.2%) but higher survival at 1 year (90.2% v 76.9%). Table 1 illustrates the demographics and findings of our study. LV function did not appear to influence survival rates.
Patients aged between 85–90 years old (79.3%) had a higher rate of surviving to discharge (83.1% v 64.7%). This group also had better survival rates at 30 days (83.1% v 64.7%) and at one year (70.8% v 54.3%).A Kaplan-Meier survival graph of all patients up to 5 years is shown in figure 1.
Conclusion To our knowledge, this is one of the largest studies reporting real life outcome for PPCI in the very elderly. Despite successful and expedient PPCI in the majority of cases, very elderly patients with STEMI had poor outcome with long hospital stays, and high mortality rates. However, most patients were able to be discharged to their own home. Women, younger patients and functionally independent individuals appear to have slightly more favourable outcomes.
This patient group needs more scrutiny to ascertain whether PPCI should be offered routinely in cases of acute STEMI.
Conflict of Interest nil
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