Percutaneous Coronary Intervention in Nonagenarians: A Single Operator Experience
Harinder K. Bali1, Amreen Dhindsa2, Kapil K Chattree3, Gagandip Singh 4, Navdeep Singh Sidhu5, Fazal Karim6, Surinder Bali7, Hiteshi K.C. Chauhan8
Paras Hospitals, India1, Paras Hospitals, Panchkula, India2, Mukat Hospital, India3, Paras Hospitals panchkula , India4, GGS Medical College, India5, PGIMER, India6, Ex professor GMC Jammu, India7, Fortis Healthcare Limited, India8
Nonagenarians represent a small fraction of patients undergoing percutaneous coronary intervention. They have been largely excluded from most randomized trials of invasive coronary procedures and so scant data is available in this regard.
We retrospectively studied data of nonagenarians who underwent percutaneous coronary intervention (PCI) in a tertiary care center, performed by a single operator from January 2011 to June 2020. Clinical profile, risk factors, treatment, procedural complications and in-hospital outcomes of these patients were analyzed.
From January 2011 to June 2020, 15 nonagenarians underwent PCI. Of these, 73% were male. The average age was 91.73+/-1.48 years. 86% were hypertensive, 40% had diabetes and 20% had chronic kidney disease. 20% had a previous history of PCI and 33% had undergone coronary artery bypass grafting in the past. 7% presented with ST-elevation myocardial infarction (STEMI), 20% with non-ST-elevation myocardial infarction and 73% with unstable angina. Acute left ventricular failure was present in 20% and cardiogenic shock in 13%. Femoral arterial route was used in 47% cases. Left main plus triple vessel disease was seen in 20%, triple vessel disease in 33.5%, double vessel disease in 33.5% and single vessel disease in 13% cases. 73% underwent multivessel PCI. A total of 28 drug eluting stents were implanted. Of these, 32% were in the LAD, 25% in RCA and LCx each, 3.5% in left main to LCx and 3.5% in left main to ramus. 11% were implanted in saphenous venous grafts. Angiographic success rate was 100%. Access site hematoma formation occurred in 2 cases. 1 patient who presented with STEMI required intra aortic balloon pump support and mechanical ventilation. There was no in-hospital mortality. The average length of stay was 5 +/- 5 days.
Triple vessel and double vessel coronary artery disease were present in a higher proportion in nonagenarians and a significant percentage underwent multivessel PCI. Despite greater complexities, the angiographic success rate approached 100% with no in-patient mortality suggesting that PCI in nonagenarians is safe and has a good clinical outcome.