Cardiac catheterisation in nonagenarians: Single center experience

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Author:
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:
JOURNAL OF GERIATRIC CARDIOLOGY
Issue:
Volume 09, Issue 02, 2012
DOI:
10.3724/SP.J.1263.2012.01042
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.

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