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Data regarding the outcomes of primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) in nonagenarians are very limited.
The aim of this study was to evaluate the trends and in-hospital outcomes in nonagenarian STEMI patients who underwent primary PCI.
Methods and Results
We used data from the Korea Acute Myocardial Infarction Registry (KAMIR: from November 2005 to January 2008) and Korea Working Group on Myocardial Infarction (korMI: from February 2008 to May 2010). During this period, the proportion of nonagenarian STEMI patients were increased more than three times (0.6% in KAMIR vs. 1.35% in korMI), while, the primary PCI use rate increased slightly (42.5% in KAMIR vs. 63.3% in korMI, p = 0.070). We identified 84 eligible study patients who underwent primary PCI within 12 hours from symptom onset. Mean age was 92.3 years and 63.1% were women. The final Thrombolysis In Myocardial Infarction (TIMI) flow 3 was achieved in 84.5% of patients (75.0% in KAMIR vs. 87.5% in korMI, p = 0.320). The overall in-hospital mortality rate was 21.4% (25% in KAMIR vs. 20.3% in korMI, p = 0.919). Other overall in-hospital outcomes including cardiogenic shock, recurrent myocardial infarction, stroke, acute renal failure and major bleeding were occurred in 14.3%, 1.2%, 1.2%, 1.2% and 0%, respectively. Stepwise logistic analysis identified 2 independent predictors of in-hospital mortality: final TIMI < 3 (odds ratio 13.7, 95% confidence interval 3.2 to 59.0, p < 0.001) and cardiogenic shock during hospitalization (odds ratio 6.7, 95% confidence interval 1.5 to 30.3, p = 0.013).
Nonagenarian STEMI patients have been increasing rapidly. Despite the primary PCI may be an effective and safe treatment strategy for these patients, its use rate did not increase. To improve survival, primary PCI should be considered actively for carefully selected patients.