Clinical Characteristics and Outcomes of Elderly Patients Undergoing Primary Percutaneous Coronary Intervention: An Observational Cohort Study

Abstract

Background: The global trend of population aging has resulted in more frequent cardiovascular disease among seniors. Primary percutaneous coronary intervention (pPCI) is the standard of care for ST-elevation myocardial infarction (STEMI) without an upper age limit. Nevertheless, the outcomes are variable among studies, and data on pPCI outcomes in the elderly in Africa is scarce. Thus, we attempted to gain better insight into the outcomes of primary PCI in this age group from a single center in upper Egypt. Objective: To study the patient characteristics and in-hospital outcomes of pPCI in elderly patients presenting with STEMI in a tertiary cardiac center in upper Egypt. Methods and results: This observational cohort study was based on data from the pPCI registry in a tertiary cardiac center in upper Egypt, which included 3,627 consecutive patients who underwent pPCI between January 2014 and June 2023. The elderly were defined as those aged 70 years or older and represented 15.9% (575 patients) of the entire cohort, of whom 103 (2.8%) were octogenarians. Clinical characteristics, procedural details, and in-hospital outcomes were compared between the age groups. The elderly had a significant trend of being female and hypertensive, and having chronic kidney disease (CKD), worse Killip class, more frequent severe non-culprit vessel lesions, and left main trunk involvement. The in-hospital mortality was significantly higher than that of younger patients (14.1 vs. 4%, p = <0.001), with higher mortality in octogenarians (23.3%). Killip class ≥II was independently associated with increased hospital mortality in all study age groups. Contrast-induced nephropathy and TIMI major bleeding were also significantly higher. Conclusion: Compared to younger patients, elderly patients undergoing pPCI had a higher prevalence of hypertension and CKD and were more likely to have a worse Killip class. The radial approach was utilized less often in the elderly group. In-hospital complications and mortality, particularly among the octogenarians, were significantly higher than in younger patients.

Keywords

• primary percutaneous coronary intervention
• elderly
• septuagenarians
• octogenarians