Original title: Outcomes After Primary Percutaneous Coronary Intervention in Octogenarians and Nonagenarians With ST-Segment Elevation Myocardial Infarction: From the Western Denmark Heart Registry. Reference: Lisbeth Antonsen et al. Catheterization and Cardiovascular Interventions 81:912–919 (2013)

With increasing life expectancy worldwide, older patients will become increasingly referred to us for angioplasty in the context of a heart attack with ST segment elevation. Often they do not receive all the available therapeutic strategy because the assumption is that their prognosis is already bad enough to not be able to change it. This is compounded by the lack of information available about the systematic exclusion of this age group in most randomized works. The aim of this study was to present the all-cause mortality at 30 days, one year and five years of octogenarians and nonagenarians who were referred for primary angioplasty between 2002 and 2009. 1,322 elderly patients were evaluated of which 91.8% were octogenarians and 8.2% nonagenarians.

The proportion of octogenarian patients referred for primary angioplasty increased from 5.5% in 2002 to 11.1% in 2009 but the proportion of nonagenarians remained stable (0.6% versus 0.8%).

12.1% of all elderly patients were admitted in a critical condition, (Killip IV, need for endotracheal intubation, balloon counterpulsation or systolic pressure

Conclusion:

The annual proportion of octogenarians referred for primary angioplasty doubled between 2002 and 2009 but the proportion of nonagenarians remained stable. While nonagenarians have the highest mortality both in the short and long term, this series showed a five-year acceptable survival rate of more than 40% in both groups.

Editorial Comment:

Although this study reports only mortality, other end points such as infarction, bleeding or kidney failure post procedure would be very useful for a correct measurement of risk / benefit. The consequence of the present behavior seems obvious with these results, so these patients should receive all the available therapeutic strategies as younger patients do. The delay in decision making may partly explain the percentage of patients admitted with hemodynamic instability.

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