Angioplasty in Nonagenarians Is Increasingly Frequent: How Does It Evolve?

Currently, the number of nonagenarian patients undergoing angioplasty (whether elective, urgent or emergency) has increased.

Pacientes que no siguen nuestro consejo y sorpresivamente tienen menos eventos

This population is linked to more comorbidities and has barely been included in most randomized studies or registries. As such, we do not have robust evidence on this group.

Researchers conducted an analysis of the J-PCI OUTCOME Registry, in which patients were divided according to their age into 4 groups: 60-69 years (13,155 patients: 32.3%); 70-79 years (16,874: 41.4%); 80-89 years (9813: 24.1%), and ≥90 years (88: 2.2%).

Compared with younger patients, the group of nonagenarians was comprised mostly of females (54%) with lower rates of diabetes, hypertension, dyslipidemia, smoking, and cardiac and renal failure. However, this group was linked to higher rates of acute coronary syndromes, left main coronary artery disease, and three-vessel lesions.

Transradial access was the least employed access in this group, and there were no differences between groups in the use of stents and drug-eluting balloons, procedure time, or bleeding in the access site. Nonetheless, there were more instances of bleeding unrelated to the access site compared with the rest of the groups.

After a 1-year follow-up, mortality and bleeding rates were higher in nonagenarian patients compared with younger patients (1.5x higher than in octogenarians).

Cardiovascular death, infarction, and stroke in patients ≥90 years old were 13.5%, 8.1%, and 6.8%, respectively, after a 1-year follow-up. Furthermore, these patients had higher rates of fatal acute coronary syndromes, heart failure, and major bleeding.

The predictors of MACE at 1 year were cardiogenic shock, cardiac arrest, and anticoagulant use.

Conclusion

Currently, nonagenarians undergoing angioplasty continue to experience a considerable increased risk of adverse cardiovascular events, which reduces their survival. In addition, they present severe injuries with adverse events including increased rates of MACE, death, and major bleeding, occurring 1.5x more often in nonagenarian patients than in octogenarians.