Demographic Profile and Short-term Outcomes of Very Elderly Patients under- going Percutaneous Coronary Intervention for Acute Coronary Syndrome - A Retrospective Analysis
Deepika Mittal1, Purushottam Mittal2, Praveen Kothari3, Meenaxi Sharda4
1 Assistant Professor, Department of community medicine, Coordinator, Medical Education Unit, Government Medical College, Kota, Rajasthan, India
2 Chief Interventional Cardiologist, Sudha Hospital, Kota, Rajasthan, India
3 Interventional Cardiologist, Sudha Hospital, Kota, Rajasthan, India
4 Professor of Medicine, Head, Department of Geriatrics, Government Medical College, Kota, Rajasthan, India
2, Jawahar Nagar, Kota, Rajasthan
Source of Support: None, Conflict of Interest: None
Objectives-Optimum Revascularization strategy in very elderly population with Acute Coronary Syndrome (ACS) is currently unclear. There is reluctance on the part of physicians to recommend Percutaneous Coronary Interventions (PCI) in India because of financial constrains and fear of the complications. In this retrospective analysis we aimed to identify the demographic profile and acute outcomes of very elderly patients who have undergone percutaneous coronary intervention as compared to those treated conservatively.
Material and Methods -Out of total cohort of 198 patients more than 80 years of age, data of 45 patients (23%) who underwent percutaneous coronary intervention were retrospectively analyzed for demographic profile, treatment strategy and short term outcomes compared with 153 conservatively treated patients.
Results- Over a period of 3.5 year, 198 patients in the very elderly group were admitted with ACS. PCI was performed in 23% of them. Patients treated with PCI were younger (84 vs 87 year), had less number of diseased vessels (1.8 vs 2.4), better LV function at admission (EF 51.3% vs 43.0%) and had less co- morbidities. In-hospital and 1 month post discharge mortality was lower in patients treated with PCI (8.8% vs 22.2% and 11.1% vs 26.1%). They also had lower re-hospitalization rate for heart failure than those treated conservatively (8.9% vs 23.5%).
Conclusion- PCI may yield better results than conservative treatment strategy in carefully selected octogenarians with one or two vessel disease with preserved ejection fraction and minimal co-morbidities who are not at a very high risk of acute contrast induced kidney injury.