Riihiniemi Matti, Piuhola Jarkko, Niemelä Matti, Biancari Fausto, Junttila Juhani
Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu, Oulu, Finland.
Department of Cardiology, Oulu University Hospital, Oulu, Finland.
Scand Cardiovasc J. 2025 Dec;59(1):2514880. doi: 10.1080/14017431.2025.2514880. Epub 2025 Jun 11.
Due to aging population, nonagenarians are increasingly undergoing percutaneous coronary intervention (PCI). However, the safety and efficacy of PCI in this elderly population remains somewhat unknown.
A retrospective study was conducted to investigate the characteristics and outcomes of consecutive nonagenarians who underwent PCI at the Oulu University Hospital between 2012 and 2022. Patients ( = 107; mean age 91.2 ± 1.4 years; 58.9% women) were stratified into three groups based on their presentation: ST-elevation myocardial infarction (STEMI), non-ST-elevation acute coronary syndrome (NSTEACS) or stable coronary artery disease (CAD). One-year mortality was the primary outcome of this analysis. Secondary outcomes were in-hospital major bleeding and 1-year rates of myocardial infarction, stroke and repeat revascularisation.
Majority had acute coronary syndrome, with STEMI in 35 (32.7%) and NSTEACS in 51 (47.7%) patients, while in 21 (19.6%) patients' indication was stable CAD. Early mortality was mainly related to STEMI (in-hospital mortality: STEMI 22.9% vs. NSTEACS 5.9% vs. stable CAD 0.0%, = 0.011; 30-day mortality: 34.3% vs. 13.7% vs. 4.8%, respectively, = 0.011). Rate of major in-hospital bleeding was 3.7%. There was no significant difference in 1-year mortality between groups (40.0% vs. 27.5% vs. 19.0%, respectively, = 0.227). One-year rates for myocardial infarction, stroke and repeat revascularisation were 7.5%, 1.9% and 3.7%, respectively.
Excess mortality in nonagenarians undergoing PCI is mainly related to STEMI where it is driven by early adverse events. Mortality in this study can be seen as acceptable in comparison to that in general population, supporting the use of PCI in selected nonagenarians.
由于人口老龄化，90多岁的老人越来越多地接受经皮冠状动脉介入治疗（PCI）。然而，PCI在这一年长人群中的安全性和有效性仍不太明确。
进行了一项回顾性研究，以调查2012年至2022年期间在奥卢大学医院接受PCI的连续性90多岁老人的特征和结局。患者（n = 107；平均年龄91.2±1.4岁；58.9%为女性）根据其临床表现分为三组：ST段抬高型心肌梗死（STEMI）、非ST段抬高型急性冠状动脉综合征（NSTEACS）或稳定型冠状动脉疾病（CAD）。1年死亡率是该分析的主要结局。次要结局为住院期间大出血以及心肌梗死、中风和再次血运重建的1年发生率。
大多数患者患有急性冠状动脉综合征，其中35例（32.7%）为STEMI，51例（47.7%）为NSTEACS，而21例（19.6%）患者的指征为稳定型CAD。早期死亡率主要与STEMI相关（住院死亡率：STEMI为22.9%，NSTEACS为5.9%，稳定型CAD为0.0%，P = 0.011；30天死亡率：分别为34.3%、13.7%和4.8%，P = 0.011）。住院期间大出血发生率为3.7%。各组之间1年死亡率无显著差异（分别为40.0%、27.5%和19.0%，P = 0.227）。心肌梗死、中风和再次血运重建的1年发生率分别为7.5%、1.9%和3.7%。
接受PCI的90多岁老人的额外死亡率主要与STEMI相关，其由早期不良事件驱动。与普通人群相比，本研究中的死亡率可被视为可接受的，支持在选定的90多岁老人中使用PCI。
