Maladies cardiovasculaires et diagnostic

Percutaneous Coronary Intervention in Nonagenarians: Prevalence, Indications, Vascular Approach and Mortality at 3 months

Abstract

Vincent Spagnoli, Quentin de Hemptinne, Mohamed Nosair, Gilbert Gosselin

Background: Percutaneous coronary intervention (PCI) in nonagenarians has been shown to be feasible, with a high success rate. However, there is paucity of data regarding the prevalence, vascular access, procedural data and mortality after PCI in this population.

Methods: All patients aged 90 and older referred to our institution from 2004 to 2014 for coronary angiogram were included in our retrospective study. Clinical and procedural data including vascular access and 3-month mortality rates were obtained for all patients.

Results: A total of 26696 PCI were performed over the last 11 years, of which 177 PCI (0.66%) were realized in 167 nonagenarians. The prevalence of PCI in nonagenarians increased from 0.17% in 2004 to 1.22% in 2014. In this population, with an age of 92 ± 2 years and 51.4% of males, 76 (43%) PCI were performed in the setting of ST-elevation myocardial infarction, and 89 (50%) of the procedures were non-ST elevation myocardial infarction or unstable angina. Transradial approach (TRA) was used in 76 (43%) and transfemoral approach (TFA) in 101 (57%) procedures. Comparing TRA to TFA, the total fluoroscopic time and contrast volume was similar between the two groups. Overall complications, including cardiogenic shock, iatrogenic coronary dissection, perforation or no reflow phenomenon occurred in 22 of 177 procedures (12.4%). Overall survival rate was 92.8% at 3 months.

Conclusion: The majority of the procedures was performed in acute coronary syndrome clinical setting. TRA and TFA were comparable in terms of fluoroscopic time and contrast volume. Overall procedural success rate was high and complication rates were low.