Temporal Trends and Improved Outcomes of Percutaneous Coronary Revascularization in Nonagenarians

Objectives The aim of this study was to describe the clinical characteristics and the outcomes of patients 90 years of age or older who were treated with percutaneous coronary intervention (PCI). Background There is a paucity of outcomes data among nonagenarians undergoing PCI. Methods We evaluated the outcomes of all patients 90 years of age or older in the Mayo Clinic PCI registry and examined trends over time. Results Over a period of 19 years, we identified 138 nonagenarians (66% women; age 92.2 +/- 2.0 years). Mean duration of hospitalization was 3.7 +/- 3.1 days, and the median follow-up duration was 3.6 years. Ninety-one percent of patients presented with an acute coronary syndrome and underwent urgent or emergent revascularization. Technical success rate was 91%. Overall, the frequency of in-hospital death, Q-wave myocardial infarction, and major adverse cardiac events (composite of death, Q-wave myocardial infarction, urgent or emergent coronary artery bypass grafting, and cerebrovascular accident) were 9.4%, 0.7%, and 12.3%, respectively. The long-term survival of the cohort was not significantly different than that of an age, gender, and calendar year of birth-matched Minnesota cohort. The cohort was divided into 2 groups according to the time of their intervention: pre-2000 (n = 32) and 2000 to 2006 (n = 106). The in-hospital mortality decreased markedly: 22% to 6% (p = 0.006), respectively. Conclusions Our study demonstrates that, in carefully selected patients, PCI in contemporary practice may be performed with high technical success with relatively low mortality and morbidity. Thus, advanced age alone must not be considered a contraindication to performing coronary angiography and PCI when clear indications are present. (J Am Coll Cardiol Intv 2008;1:692-8) (C) 2008 by the American College of Cardiology Foundation