PMID- 33435875
OWN - NLM
STAT- MEDLINE
DCOM- 20210614
LR  - 20210614
IS  - 1471-2261 (Electronic)
IS  - 1471-2261 (Linking)
VI  - 21
IP  - 1
DP  - 2021 Jan 13
TI  - Primary percutaneous coronary intervention in nonagenarians: is it worthwhile?
PG  - 30
LID - 10.1186/s12872-020-01833-2 [doi]
LID - 30
AB  - BACKGROUND: Previous studies have demonstrated the feasibility of primary 
      percutaneous coronary intervention (PPCI) in carefully selected nonagenarians. 
      Although current guidelines recommend immediate revascularization in patients 
      with ST elevation myocardial infarction (STEMI) it remains unclear whether PPCI 
      reduces mortality in nonagenarians. The objective of this study is to compare 
      mortality in nonagenarians presenting via the PPCI pathway who undergo coronary 
      intervention, versus those who are managed medically. METHODS AND RESULTS: A 
      total of 111 consecutive nonagenarians who presented to our tertiary center via 
      the PPCI pathway between July 2013 and December 2018 with myocardial infarction 
      were included. Clinical and angiographic details were collected alongside data on 
      all-cause mortality. The final diagnosis was STEMI in 98 (88.3%) and NSTEMI in 13 
      (11.7%). PPCI was performed in 42 (37.8%), while 69 (62.2%) were medically 
      managed. A significant number of the medically managed cohort had atrial 
      fibrillation (23.2% vs 2.4% p = 0.003) and presented with a completed infarct 
      (43.5% vs 4.8% p = 0.001). Other baseline and clinical variables were well 
      matched in both groups. There was a trend towards increased 30-day mortality in 
      the medically managed group (40.6% vs 23.8% p = 0.07). Kaplan Meier survival 
      analysis demonstrated a significant difference in survival by 3 years (48.1% vs 
      21.7% p = 0.01). This was the case even when those with completed infarcts were 
      excluded (44.3% vs 14.6%, p = 0.01). CONCLUSION: In this series of selected 
      nonagenarians presenting with acute myocardial infarction, those undergoing PPCI 
      appeared to have a lower mortality compared to those managed medically.
FAU - Meah, Mohammed M N
AU  - Meah MMN
AD  - Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, L14 3PE, UK.
FAU - Joseph, Tobin
AU  - Joseph T
AUID- ORCID: 0000-0002-9283-9895
AD  - Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, L14 3PE, UK. 
      t.joseph@doctors.org.uk.
FAU - Ding, Wern Yew
AU  - Ding WY
AD  - Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, L14 3PE, UK.
FAU - Shaw, Matthew
AU  - Shaw M
AD  - Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, L14 3PE, UK.
FAU - Hasleton, Jonathan
AU  - Hasleton J
AD  - Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, L14 3PE, UK.
FAU - Palmer, Nick D
AU  - Palmer ND
AD  - Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, L14 3PE, UK.
FAU - Velavan, Periaswamy
AU  - Velavan P
AD  - Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, L14 3PE, UK.
FAU - Aggarwal, Suneil K
AU  - Aggarwal SK
AD  - Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, L14 3PE, UK.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
DEP - 20210113
PL  - England
TA  - BMC Cardiovasc Disord
JT  - BMC cardiovascular disorders
JID - 100968539
RN  - 0 (Cardiovascular Agents)
SB  - IM
MH  - Age Factors
MH  - Aged, 80 and over
MH  - Cardiovascular Agents/adverse effects/*therapeutic use
MH  - Clinical Decision-Making
MH  - Comorbidity
MH  - Coronary Artery Disease/diagnosis/mortality/*therapy
MH  - Female
MH  - Humans
MH  - Male
MH  - Non-ST Elevated Myocardial Infarction/diagnosis/mortality/*therapy
MH  - *Percutaneous Coronary Intervention/adverse effects/mortality
MH  - Retrospective Studies
MH  - Risk Assessment
MH  - Risk Factors
MH  - ST Elevation Myocardial Infarction/diagnosis/mortality/*therapy
MH  - Time Factors
MH  - Treatment Outcome
PMC - PMC7805235
OTO - NOTNLM
OT  - Myocardial infarction
OT  - Nonagenarian
OT  - Primary PCI
COIS- All authors confirm that they have no competing interests.
EDAT- 2021/01/14 06:00
MHDA- 2021/06/16 06:00
PMCR- 2021/01/13
CRDT- 2021/01/13 05:42
PHST- 2020/09/29 00:00 [received]
PHST- 2020/12/21 00:00 [accepted]
PHST- 2021/01/13 05:42 [entrez]
PHST- 2021/01/14 06:00 [pubmed]
PHST- 2021/06/16 06:00 [medline]
PHST- 2021/01/13 00:00 [pmc-release]
AID - 10.1186/s12872-020-01833-2 [pii]
AID - 1833 [pii]
AID - 10.1186/s12872-020-01833-2 [doi]
PST - epublish
SO  - BMC Cardiovasc Disord. 2021 Jan 13;21(1):30. doi: 10.1186/s12872-020-01833-2.