Author + information
- Maddury Jyotsna,
- Anil Enikapalli,
- Nagendra Prasad Kulari and
- Indrani Garre
Cardiovascular (CV) disease is the most frequent diagnosis in elderly people and it is the leading cause of death in both men and women older than 65 years of age. Historically elderly are prone to more conservative and use less aggressive therapies. Nevertheless, given their high-risk status, the elderly with heart disease are also a group that is very likely to experience improvements in clinical outcomes and functional status with revascularization. However, they are also more likely to experience procedural complications, owing to age-related physiological changes, frailty, and Comorbidities.
The limited representation of elderly patients in clinical trials has resulted in fewer data about the effectiveness of various strategies in this population.
Material and Methods
This is a retrospective observation study. In this study we have analyzed demographic, clinical, angiographic, procedural characteristics of octo and nanogenerian patients who were undergone PCI for CAD between 2010 to 2015 in NIMS.
Total 174 patients has undergone PCI in the given period, of them 78% were males & 22% were females. The mean age is 82.4±2.8 yrs with maximum of 99yrs. Only 3 nanogenerian patients underwent PCI. 94 patients (54%) presented with CSA, rest of them with Acute coronary syndrome. Of patients presented with CSA, 40% have evidence of ischemia in ECG in the form of ST/T changes. 64% Patients have normal LV function at presentation. Among patients with LV dysfunction, mild LV dysfunction is seen in 70%patients. 69% patients had single vessel disease of them LAD disease is more common followed by RCA then LCX. Requirement of pre-dilatation is seen in 88% patients due to presence of tight narrowing / calcification. Stenting is not possible in 8 (4.6%) patients due to severe calcification. BMS implantation done in 25 patients & DES implantation in 141 patients. Procedural success is seen in 95.4% patients which is comparable to younger age group patients. 32% patients required stents of length > 20mm. Diameter of all the stents is >2.5 mm. Only 4% patients procedural complications in the form of major bleed or pseudoaneurysm /CIN.
The acute success of PCI is high (95.4%) in octo and nanogenerians with minimal complication rates (4%). So, PCI may be one of the preferred modalities of treatment in PCI suitable cases. However, many lesions (88%) required pre-dilatation due to calcific lesion or tighter stenosis.