Cardiac catheterisation in nonagenarians: Single center experience

( views:301, downloads:0 )
Marc-Alexander Ohlow(Department of Cardiology, Zentralklinik Bad Berka, Robert Koch-Allee 9, 99437 Bad Berka, Germany)
Aly Hassan(Department of Cardiology, Faculty of Medicine, Alexandria University, El-Guish Road, El-Shatby, Alexandria 21526, Egypt)
Ulrich Lotze(Department of Internal Medicine, DRK Krankenhaus Sonderhausen, Hospitalstrasse 2, 99706 Sondershausen, Germany)
Bernward Lauer(Department of Cardiology, Zentralklinik Bad Berka, Robert Koch-Allee 9, 99437 Bad Berka, Germany)
Journal Title:
Volume 09, Issue 02, 2012
Key Word:
Nonagenarian;Acute coronary syndrome;Complications;Coronary angiography

Abstract: Objective To explore the treatment, procedure related risks, and outcomes of patients older than 90 years of age undergoing cardiac catheterization. Methods We retrospectively studied 32 patients ≥ 90 years (93.0 ± 1.2 years) who underwent cardiac catheterisation in a tertiary specialist hospital (0.2% of 14,892 procedures during three years). The results were compared to a patient cohort younger than 90 years of age. Results Baseline characteristics revealed a higher prevalence of diabetes (P < 0.001), chronic obstructive pulmonary disease (P < 0.04), previous myocardial infarction (P < 0.02), and complex coronary anatomy (SYNTAX score 33 vs. 19) in nonagenarians. Patients < 90 years of age showed more hyperlipidemia (P < 0.01) and previous percutaneous coronary interventions (P < 0.015). Nonagenarians underwent coronary angiography more often for acute coronary syndrome (ACS) (P < 0.003), were presented more often in cardiogenic shock (P < 0.003), and were transferred faster to coronary angiography in cases of ACS (P < 0.0001). The observed in-hospital mortality rate (13% study group vs. 1% control group; P < 0.003) in nonagenarians was lower than the calculated rate of thrombolysis in myocardial infarction (TIMI) and global registry of acute cardiac events (GRACE) mortality and strongly influenced by the severity of clinical presentation and the presence of co-morbidities. Conclusion Despite the common scepticism that cardiac catheterisation exposes patients ≥ 90 years to an unwarranted risk, our data demonstrate an acceptable incidence of complications and mortality in this group of patients.

  • [1]Fisher I.Lengthening of human life in retrospect and prospect.Am J Publ Health 1927;17:1–10.
  • [2]Schwabe U,Paffrath D.Arzneimittelverordnungs-Report 2006;Springer-Verlag:Heidelberg 2007;437.
  • [3]Specer G.Projections of the Population of the United States by Age,Sex,and Race,1988 to 2080.In Current Population Reports;U.S.Bureau of the Census:Washington,DC,USA,1989;Series P-25,No.1018.
  • [4]Niebauer J,Sixt S,Zhang F,et al.Contemporary outcome of cardiac catheterisations in 1085 consecutive octogenarians.Int J Cardiol 2004;93:225–230.
  • [5]Lee P,Alexander K,Hammil B,et al.Representation of elderly persons and women in published randomized trials of acute coronary syndromes.J Am Assoc 2001;286:708–713.
  • [6]Antman EM,Cohen M,Bernink PJ,et al.The TIMI risk score for unstable angina/non-ST elevation MI:a method for prognostication and therapeutic decision making.JAMA 2000;284:835–842.
  • [7]Granger CB,Goldberg RJ,Dabbous O,et al.Predictors of hospital mortality in the global registry of acute coronary events.Arch Intern Med 2003;163:2345–2353.
  • [8]Serruys P,Onuma Y,Garg S,et al.Assessment of the SYNTAX score in the syntax study.EuroIntervent 2009;5:55–56.
  • [9]Widimsky P,Motovska Z,Bilkova D,et al.The impact of age and Killip class on outcomes of primary percutaneous coronary intervention.Insight from the PRAGUE-1 and -2 trials and registry.EuroInterv 2007;2:481–488.
  • [10]Batchelor W,Anstrom K,Muhlbaier L,et al.Contemporary outcome trends in the elderly undergoing percutaneous coronary interventions:results in 7472 octogenarians.J Am Coll Cardiol 2000;36:723–730.
  • [11]Skolnik A,Alexander K,Chen A,et al.Characteristics,management,and outcomes of patients age ≥ 90 years with acute coronary syndromes.J Am Coll Cardiol 2007;49:1790–1797.
  • [12]Balzi D,Barchielli A,Buiatti E,et al.Effect of comorbidity on coronary reperfusion strategy and long-term mortality after acute myocardial infarction.Am Heart J 2006;151:1094–1100.
  • [13]Liistro F,Angioli P,Falsini G,et al.Early invasive strategy in elderly patients with non-ST elevation acute coronary syndrome:comparison with younger patients regarding 30-day and longterm outcome.Heart 2005;91:1284–1288.
  • [14]Hochmann J,Sleeper L,Webb J,et al.Early revascularization in acute myocardial infarction complicated by cardiogenic shock.N Engl J Med 1999;341:625–634.
  • [15]Klein L,Block P,Brindis R,et al.Percutaneous coronary interventions in octogenarians:development of a nomogram predictive of in-hospital mortality.J Am Coll Cardiol 2002;40:394–402.
  • [16]Cohen H,Williams D,Holmes D,et al.Impact of age on procedural and 1-year out-come in percutaneous transluminal coronary angioplasty.Am Heart J 2003;146:513–519.
  • [17]Teplitsky I,Assali A,Golovchiner G,et al.Acute and intermediate-term results of percutaneous coronary stenting in octogenarian patients.Int J Cardiovasc Interv 2004;4:195–199.
  • [18]Frenkiel N.Cardiovascular data in 13 nonogenarians.Geriatrics 1959;9:559–561.
  • [19]Huang Y,Chen M,Fang C,et al.A possible link between exercise-training adaptation and dehydroepiandrosterone sulphate an oldest-old female study.Int J Med Sci 2006;3:141–147.
  • [20]Mills T,Smith H,Vlietstra R.PTCA in the elderly:results and expectations.Geriatrics 1989;44:71–79.
  • [21]Danzi G,Centola M,Pomidossi G,et al.Usefulness of primary angioplasty in nonagenarians with acute myocardial infarction.Am J Cardiol 2010;106:770–773.
  • [22]Koutuozis M,Grip L,Matejka G,et al.Primary percutaneous coronary interventions in nonagenarians.Clin Cardiol 2010;33:157–161.
  • [23]Lefevre T,Morice M,Eltchaninoff H,et al.One-month results of coronary stenting in patients 》 75 years of age.Am J Cardiol 1998;82:17–21.
  • [24]Lenzen M,Boersma E,Bertrand M,et al.Management and outcome of patients with established coronary artery disease:the Euro Heart Survey on coronary revascularisation.Eur Heart J 2005;26:1169-1179.
WanfangData CO.,Ltd All Rights Reserved
About WanfangData | Contact US
Healthcare Department, Fuxing Road NO.15, Haidian District Beijing, 100038 P.R.China
Tel:+86-010-58882616 Fax:+86-010-58882615