Assessment of Primary Percutaneous Coronary Intervention Outcomes in Elderly and Very Elderly Patients

Background: To date, data regarding safety and efficacy of primary percutaneous coronary intervention (P-PCI) in elderly patients are scarce. We aimed to assess the outcomes of P-PCI in the elderly subgroup, and to evaluate whether the advantages of P-PCI diminish with advanced ages.

Methods: This retrospective study included elderly patients who underwent P-PCI for acute STEMI. Patients were sub grouped according to their age into three groups (Group A: aged 75-84, Group B: aged ³85 and control Group C: aged 65-74). The primary endpoint was in-hospital and 30-day all-cause mortality, and secondary endpoints were MACE (death, stroke, MI or re-PCI), stroke, vascular complication, bleeding and transfusion, target vessel re-intervention, contrast induced acute kidney injury (CI-AKI) and gastrointestinal (GI) bleeding.

Results: A total of 1111 patients were included with 339 patients in group A, 95 patients in group B and 677 patients in the control group C. In terms of the primary endpoint of our study, no significant difference could be detected between the studied groups. CI-AKI was the only secondary outcome to show a significant difference (P =0.005). Arterial hypertension and a previous history of chronic kidney disease (CKD) were independent predictors of in-hospital mortality, with OR 5.336, 95% CI 1.187 – 23.998 and OR 11.024, 95% CI 2.104 – 57.756, respectively. Additionally, final TIMI flow less than 3 (OR 42.322, 95% CI 5.674 – 315.667) and bleeding that required blood transfusion (OR 87.144, 95% CI 3.086 – 2460.628) showed higher risk of in-hospital MACE.

Conclusion: our study revealed that outcomes of P-PCI for STEMI in elderly population (³75) are favourable and comparable to younger patients. Therefore, P-PCI should be offered to every elderly patient presenting with acute STEMI, after considering risk factors for mortality and MACE in this special age group.