Primary Percutaneous Coronary Intervention in Elderly Patients with Acute Myocardial Infarction: A Single Centre Experience from Southern India

Abstract

Introduction: Due to increasing life expectancy, the elderly population is constantly rising globally and the number of older patients presenting with Acute Coronary Syndrome (ACS) and Acute Myocardial Infarction (AMI) is also on the rise. The treatment of choice for patients suffering from acute ST Elevation Myocardial Infarction (STEMI) is Primary Percutaneous Coronary Intervention (Primary PCI). However, Primary PCI in elderly patients is thought to carry higher mortality and morbidity when compared to general population due to multiple co-morbidities and other factors. Aim: To evaluate the clinical outcomes of Primary Angioplasty in Myocardial Infarction (PAMI) in elderly south Indian patients, attending a single center. Materials and Methods: This was a retrospective, non-randomised, single center observational study, conducted at a tertiary care centre in southern India, between January 2015 and December 2017. Consecutive elderly patients (aged ≥65 years) who underwent primary angioplasty for acute STEMI were studied. The clinical endpoint of cumulative incidence of Major Adverse Cardiac Events (MACE), which included composite of cardiac death, Myocardial Infarction (MI) and Target Vessel Revascularisation (TVR) were analysed. The MACE during one, six and twelve months follow-up after procedure was noted as documented in the hospital records. Results: The mean age of 103 patients was 79.23±3.61 years, and 67% (69) patients were males. Amongst those enrolled patients, 58.3% (60) were hypertensive and 50.5% (52) were diabetic. Single vessel disease was present in 57.3% (59) patients and 30.1% (31) patients had isolated Left Anterior Descending (LAD) artery lesion and 53.4% (55) had combined LAD and one other vessel lesions. At 12th month follow-up, the cumulative incidence of MACE was 8.73% (9) in the form of cardiac deaths 7.77% (8) and TVR 0.97% (1). There were 3.88% (4) patients who suffered stroke. Conclusion: The lower rate of MACE reported in the present study implies that, for the management of AMI in elderly patients, the primary angioplasty is advantageous and can be performed safely.

Keywords

• acute coronary syndrome
• major adverse cardiac events
• primary angioplasty in myocardial infarction