Abstract 1753: Lower Procedural Success and Higher Complications in Octogenarians with STEMI Referred for Emergency Cardiac Catheterization: Results from the American College of Cardiology - National Cardiovascular Data Registry (ACC-NCDR®)
Background: Primary PCI has become the treatment of choice for patients with ST segment elevation myocardial infarction (STEMI), but the effectiveness of implementing a strategy of emergency catheterization and primary PCI in octogenarians is not known. We hypothesized that older patients would have more severe coronary disease, lower procedural success, and higher rates of procedural complications that might ultimately reduce the effectiveness of this strategy.
Methods: We identified all STEMI patients in the ACC National Cardiovascular Data Registry Cath/PCI registry who underwent emergency catheterization in 2005. Patients transferred from another hospital, with prior CABG, or who received fibrinolytic therapy were excluded. We examined characteristics and presenting cardiac status, and compared coronary anatomy, rates of primary PCI, procedural complications, and in-hospital outcomes of patients ≥ 80 years with patients aged < 80.
Results: Of the 19,229 patients eligible for analysis, 1,904 (10.0%) were ≥ 80. Octogenarians were more likely than younger patients to present with heart failure or cardiogenic shock and have left main or 3 vessel disease (all P < 0.001). They were less likely to undergo primary PCI (83.7% Vs 86.5%, P = 0.001). Among patients with primary PCI, octogenarians had more lesions approached (P < 0.001), but were less likely to achieve TIMI 3 flow (89% vs 93%; P < 0.001). Unadjusted rates of bleeding, vascular complications, and in-hospital death were all significantly higher in octogenarians (Table⇓).
Conclusions: In this unselected cohort of STEMI patients referred for emergency catheterization, octogenarians were less likely to have anatomy amenable to PCI, less likely to achieve TIMI 3 flow, and at higher risk of procedural complications. These factors contribute to the higher in-hospital mortality and highlight the need for additional studies to determine the benefits of primary PCI in this vulnerable population.