It is not too late for ... percutaneous angiography in a 90-plus population

Abstract

Funding Acknowledgements Type of funding sources: None. Introduction Elderly people represent a vulnerable but increasing population presenting to percutaneous coronary intervention (PCI). The benefit of revascularization in acute coronary syndromes (ACS) is well-stablished. However, the benefit in elderly patients has been questioned, considering the patient’s expected survival, functional and cognitive status, comorbidities, procedure’s risk and need for extended anti-thrombotic therapy. Purpose To evaluate the effect of PCI on the prognosis of a group of very old patients with acute coronary syndrome (ACS). Methods We retrospectively analyzed all consecutive very old patients (≥90-year-old) admitted with ACS submitted to coronarography (CA) in one tertiary center, from January 2008 to December 2021. Clinical features were collected, including major adverse cardiac events (MACE), a defined composite endpoint of all-cause death, ischemic stroke, ACS, or hospitalization for acute heart failure, which were compared according if PCI was performed or not. Q-square, Cox regression and Log-rank tests were applied. Results A total of 79 patients were enrolled; 43 of them underwent PCI. Groups were comparable in basal characteristics, with similar median age at the event (92 years old, interquartile range IQR: 3), see picture 1. Most patients with ST-elevation (STE) ACS (n=45) had PCI (70% vs. 41%, p= 0,01), while in non ST-elevation (NSTE) ACS and unstable angina there was higher proportion of non-PCI (30% vs. 58%, p= 0,01). Individuals submitted to PCI were more likely to have single or double lesion vessel (76% vs 27%, p<001), while non-PCI patients presented more complex disease (23% vs 25%, p=0,5). Among the PCI-patients, the majority was singly revascularized (86%) and submitted to stent implantation (83%). Regarding in-hospital mortality, there was no difference between groups: 21% in the PCI group versus 33% in the non-PCI control group (p=0.2). During median follow-up time of 6 months (IQR: 27), mortality was similar in both groups (79% vs 67%; p=0.1). Nevertheless, overall MACE-free survival was significantly longer in PCI group than in the no-PCI group, and PCI treated patients had a risk of MACE 52% lower than the patients assigned to medical therapy (hazard ratio 0.508, p=0.007); see picture 2. Conclusion Very old patients presenting with ACS treated with either PCI presented longer MACE-free survival. These finding suggest that very old patients with ACS and single vessel disease may benefit systematically from PCI with stent. Efforts should be made to optimize care in this under-represented population in the clinical trials.