Primary percutaneous coronary intervention (PPCI) in octogenerians: Clinical characteristics and outcomes in an Australian regional setting

Abstract

Background: The Sunshine Coast Hospital and Health Service (SCHHS), Queensland, Australia began a PPCI service in 2012. The region has a large elderly population with proportions of >65 year old residents projected to increase from 18% in 2011 to 21.8% by 2026 with >85 year olds trebling over this period. Aim: To compare PPCI characteristics and outcomes in the elderly (>80yrs) verses non-elderly (<80yrs) STEMI population treated within SCHHS. Methods & Results: Data on all PPCI patients since commencement to January 2015 were collected prospectively. Of 405 PPCI, 61(15%) were elderly. Compared to the younger cohort, the elderly were more likely to be female (38%v22%, p=0.01), had previous CABG (10%v3%, p=0.002), and have hypertension (67%v44%, p=0.002). Elderly patients had marginally longer (non-significant) median [interquartile range] door-to-balloon times (DTBT) (50 [63] v 45 [50] mins, p=0.27), were less likely to receive ticagrelor (48%v62%, p=0.13) or IIb/IIIa inhibitor (38%v56%, p=0.013) and more likely to receive bare metal stents (36%v20%) or no stent (26%v23%). Thirty-day mortality in the elderly cohort was higher (18%v3%, p<0.001). Of the eleven elderly deaths, four had cardiac arrest, three arrived intubated and ventilated, three had LMCA culprit and only five received PCI. For those receiving PCI who subsequently died, median DTBT was 106 [99] mins. Conclusion: Octogenarians represent a substantial proportion of referrals for primary PCI and is expected to increase. Timely PPCI is feasible in this inherently high-risk group however mortality is higher compared to a younger cohort.<br />