Early and late clinical outcome in elderly patients after revascularization with Primary Percutaneous Coronary Intervention presenting with acute ST-elevation myocardial infarction: Results from Qassim Primary Angioplasty Services (QAPAS) registry

摘要

Objectives We sought to investigate the procedural success rates, in hospital and 2years clinical outcomes of Primary Percutaneous Coronary Intervention in patients older than 75years presenting with acute myocardial infarction. Methods Total of 50 patients, 75years or older were enrolled in the retrospective data analysis. Primary end-points were procedural success, in hospital, short-term (1month) and long-term (2years) all cause mortality. Secondary end-points were recurrent MI, stroke, new revascularization. Results Mean age was 80.5±5.75years (range 75–96), 82% males, 18% females, 28 (56%) patients presented with anterior wall MI, 19 (38%) with inferior wall MI and 2 (4%) had posterior wall MI. All underwent PPCI achieving a door to balloon time of 140±50min (range 52–227min) and CAG revealed SVD 16.5%, 2VD 29%, 3VD 54% and involvement of left main in 14.5% of cases. A total of 68 stents were deployed, mean stent length of 33.29mm using DES in 42 patients (85.5%) and BMS in 2 patients (4%). Thirty (60%) patients received Glycoprotein IIbIIIa inhibitors. Successful recanalization of IRA was achieved in 90% of patients with 82% achieving TIMI III flow while no reflow occurred in 2 patients. Procedure related coronary artery dissection occurred in 2 patients. Mechanical complications like severe MR and severe LV dysfunction were observed in 4% and 16% of the cases, respectively. One patient had a massive fatal haemoptysis. In-hospital mortality was 18%. One-month and 2years mortality were 2.5% ( n =1) and 11% ( n =4), respectively. Older age, Gp IIb IIIa use and higher Killip Class were associated with higher overall mortality. The incidence of recurrent MI and repeat revascularization was 4% and 7%, respectively. Conclusions Our data reveal that in elderly patients primary PCI is a feasible revascularization strategy and such patients have a high in-hospital mortality and complication rates.