Comorbidities and Complications in Nonagenarians Undergoing Coronary Angiography and Intervention

Abstract

SummaryElderly people represent the fastest growing portion of cardiovascular patients. We aimed to analyze the clinical presentation, risk factors, co-morbidities, complications, and mortality in patients 90 years or more who underwent coronary angiography and intervention.We retrospectively studied 108 (0.25% of 43,385) consecutive patients ≥ 90 years undergoing cardiac catheterization and/or intervention in a tertiary specialist hospital between 2003 and 2014.Most patients (68.5%) were introduced on an emergency basis, especially with acute coronary syndrome (ACS) (63.8%). Non-STEMI accounted for two-thirds of the myocardial infarctions. We found higher prevalences of previous coronary artery disease (CAD) (38%), other atherosclerotic diseases (20.4%), cardiac risk factors such as hypertension (84.3%), diabetes (49.1%), hyperlipidemia (50.9%), heart failure (42.6%), atrial fibrillation (AF) (25.0%), severe aortic stenosis (13.0%), severe mitral regurgitation (3.7%), and implantable devices (25.0%), and co-morbidities such as renal impairment (48.1%), COPD (12.0%), and previous stroke (6.5%). Three-vessel disease was present in 34.6% of the patients. The left anterior descending artery (LAD) was the most affected coronary artery (67.6%). Percutaneous coronary intervention (PCI), mostly with bare metal stents (BMS), was used to manage 54.6% of the patients, and it failed in 4 of the patients. Conservative treatment was used in 39.8% of the patients and 15.7% had no significant CAD.The incidences of vascular complications, such as bleeding (6.5%), bleeding in other organs (6.5%), blood transfusion (6.5%), in-hospital paroxysmal atrial fibrillation (7.4%), in-hospital successful reanimation (2.8%), complete heart block (5.6%), acute renal impairment (23.1%), associated infection (25.9%), cardiogenic shock (14.8%), and death (15.7%) were high.Considering the more extensive risk factors, CAD and co-morbidities, acute presentation and age per se, we believe that the reported higher rates of complications and mortality are still acceptable. (Int Heart J 2017; 58: 180-184)

Safety of Reversing Anticoagulation by Protamine Following Elective Transfemoral Percutaneous Coronary Intervention in the Drug-Eluting Stent Era

“…[1][2][3] The access site is an important determinant of bleeding complications following PCI, 4) and the incidence of bleeding complications is significantly lower in transradial PCI than in transfemoral PCI. 5) Although radial arteries have been widely used in current PCI, including primary PCI, 6) transfemoral PCI remains necessary for complex PCI requiring a !7 Fr guide system such as chronic total occlusion or severely calcified lesions.…”

Increased mortality in octogenarians treated for lifestyle limiting claudication

“…Octogenarians fared worse in exacerbation of CHF (younger cohort = 7.5% versus octogenarians = 10.7%, P < 0.001) and AKI (younger cohort = 2.0% versus octogenarians = 2.8%, P < 0.001). These observations have been reported in elderly patients undergoing coronary interventions . Therefore, the need to explore alternative treatment modalities such as SET and maximal medical management; which to date, have not reached the goals of our professional societies .…”

9‐month results of polymer‐free sirolimus eluting stents in young patients compared to a septuagenarian and octogenarian all‐comer population

“…All patients were treated with PF‐SES angioplasty (Coroflex© ISAR, B.Braun Melsungen AG, Germany). Briefly, its cobalt‐chromium bare metal backbone has ultra‐thin struts (50/60 µm) which are sand‐blasted to create a microporous, abluminal surface for the polymer‐free matrix consisting of sirolimus (1.2 μg/mm stent surface), and probucol as the excipient to modulate drug elution.…”

“…The significance level α of 0.05 was used for all tests. The two‐sided Fisher's exact test or the Chi statistic were used whenever applicable for dichotomous variables, whereas continuous variables were compared with the unpaired t ‐test or the Mann‐Whitney U ‐test in case the Shapiro‐Wilk test revealed a strong deviation from a normal distribution. Kaplan‐Meier survival analyses were conducted based on the log‐rank test.…”

“…The very elderly age group (≥85 years) amounting to 6.5 million in 2015, will double between 2030 and 2035 according to the US census (US census bureau, 2017) . It represents therefore the fastest growing segment of patients with cardiovascular disease …”