Author + information
- Yukio Mizuguchi,
- Sho Hashimoto,
- Takeshi Yamada,
- Norimasa Taniguchi,
- Shunsuke Nakajima,
- Tetsuya Hata and
- Akihiko Takahashi
Transradial coronary intervention (TRI) for elderly patients with ST-segment elevation myocardial infarction (STEMI) is technically demanding because of difficulties in radial puncture and catheter advancement and poor backup support from the tortuosity of the subclavian and common carotid artery. This study aimed to evaluate whether the feasibility and efficacy of TRI is similarly observed in elderly STEMI patients.
We retrospectively evaluated the clinical outcomes of 391 STEMI patients underwent percutaneous coronary intervention in our institute between January 2008 and December 2014. For patients other than those undergoing hemodialysis for chronic renal failure and poor radial pulsation owing to a previous TRI procedure or cardiopulmonary arrest, we chose the right radial artery as the primary approach site. The intent-to-treat population with TRI comprised was 369 patients (93.8%).
Of the patients treated by TRI during the study period, 122 (33.1%) were aged ≥ 75 years and 247 (66.9%) were aged < 74 years. The procedural success rate was similar between the 2 groups (97.5% and 98.5%, respectively). One patient in the patients aged ≥ 75 years group was converted from the radial to femoral artery because of the tortuosity of the subclavian and common carotid arteries. The door-to-balloon time was similar between the 2 groups (44.9 vs. 42.7 minutes; p = 0.39). The peak creatinine kinase levels were lower in the patients aged ≥ 75 years than in those aged ≤ 74 years (2110 vs. 2599 IU/L; p < 0.05). The 30-day mortality rates were significantly higher in the patients aged ≥ 75 years than in those aged ≤ 74 years (5.7% vs. 1.2%, p < 0.05), which might be attributed to the fact that the patients aged ≥ 75 years more frequently had multiple coronary artery stenosis and more likely had a cardiogenic shock.
TRI is equally feasible and effective for patients with STEMI aged >75 years and for younger patients. The prognosis of elderly patients with STEMI remains poor despite successful reperfusion with TRI, probably because of the complexity of coronary lesions.