NEW YORK (Reuters Health) – Very elderly patients with ST-segment elevation MI can do quite well with successful primary percutaneous intervention, as long they aren’t in cardiogenic shock at presentation, an Italian study shows.

The findings come from a review of over 5,000 primary angioplasties that included 100 patients who were at least 90 years old. Dr. Gian Battista Danzi at Ospedale Maggiore Policlinico in Milan and colleagues analyzed 6-month outcomes in those 100 nonagenarians, and report the findings in the American Journal of Cardiology

The patients ranged in age from 90 to 98. Nineteen of them presented with cardiogenic shock. “The procedure was successful in 85 patients, complicated in 11, and failed in 4,” the authors report. “Abciximab was administered in 45% of cases.”

Overall in-hospital mortality was 19%; 11 of the 19 patients in cardiogenic shock died (58%), compared with 8 of 81 without shock (10%). The mean length of hospitalization was 7 days.

Survival at 6 months was 68%. Factors independently associated with 6-month mortality were cardiogenic shock before PCI (hazard ratio 10.82), restored myocardial TIMI flow after PCI (HR 0.19), and abciximab administration (HR 0.32).

On that point, the authors note that an “unexpectedly large proportion” of patients (45%) were given abciximab, which is believed to benefit younger patients more than the elderly. However, “procedural administration of abciximab was safe and did not lead to any episodes of major bleeding or thrombocytopenia,” Dr. Danzi and colleagues found.

All in all, they conclude, “(1) selected nonagenarians presenting with STEMI without cardiogenic shock benefit from successful primary angioplasty and (2) administration of abciximab seems to be associated with a decrease in 6-month mortality.”

Reference:

Usefulness of Primary Angioplasty in Nonagenarians With Acute Myocardial Infarction

Am J Cardiol 2010.