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Temporal Trends and Improved Outcomes of Percutaneous Coronary Revascularization in Nonagenarians

Aaron M. From, MD^_*, Charanjit S. Rihal, MD, FACC^_*, Ryan J. Lennon, MS, David R. Holmes, Jr, MD, FACC^_*, Abhiram Prasad, MD, FRCP, FACC^_*,_*

^_* Division of Cardiovascular Diseases and Department of Internal Medicine, Mayo Clinic College of Medicine and Mayo Foundation, Rochester, Minnesota
Division of Biostatistics, Mayo Clinic College of Medicine and Mayo Foundation, Rochester, Minnesota

^_* Reprint requests and correspondence: Dr. Abhiram Prasad, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905 (Email: prasad.abhiram{at}mayo.edu).

Objectives: The aim of this study was to describe the clinical characteristics and the outcomes of patients 90 years of age or older who were treated with percutaneous coronary intervention (PCI).

Background: There is a paucity of outcomes data among nonagenarians undergoing PCI.

Methods: We evaluated the outcomes of all patients 90 years of age or older in the Mayo Clinic PCI registry and examined trends over time.

Results: Over a period of 19 years, we identified 138 nonagenarians (66% women; age 92.2 ± 2.0 years). Mean duration of hospitalization was 3.7 ± 3.1 days, and the median follow-up duration was 3.6 years. Ninety-one percent of patients presented with an acute coronary syndrome and underwent urgent or emergent revascularization. Technical success rate was 91%. Overall, the frequency of in-hospital death, Q-wave myocardial infarction, and major adverse cardiac events (composite of death, Q-wave myocardial infarction, urgent or emergent coronary artery bypass grafting, and cerebrovascular accident) were 9.4%, 0.7%, and 12.3%, respectively. The long-term survival of the cohort was not significantly different than that of an age, gender, and calendar year of birth-matched Minnesota cohort. The cohort was divided into 2 groups according to the time of their intervention: pre-2000 (n = 32) and 2000 to 2006 (n = 106). The in-hospital mortality decreased markedly: 22% to 6% (p = 0.006), respectively.

Conclusions: Our study demonstrates that, in carefully selected patients, PCI in contemporary practice may be performed with high technical success with relatively low mortality and morbidity. Thus, advanced age alone must not be considered a contraindication to performing coronary angiography and PCI when clear indications are present.

Key Words: percutaneous coronary intervention • nonagenarians • age • outcomes

Abbreviations and Acronyms   CABG = coronary artery bypass grafting   IQR = interquartile range   MACE = major adverse cardiac events   MI = myocardial infarction   PCI = percutaneous coronary intervention(s)   TLR = target lesion revascularization

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