Clinical evaluation of direct percutaneous coronary intervention in patients over 80 years with acute myocardial infarction

Objective To assess the clinical efficacy and safety of direct percutaneous coronary intervention (PCI) in patients over 80 years with acute myocardial infarction (AMI). Methods Direct PCI was performed in 94 patients over 80 years with AMI in our hospital. The operation success rate, complications, mortality, major adverse cardiac event and left ventricular ejection fraction (LVEF) were recorded during hospitalization. Results Coronary angiography showed thrombolysis in myocardial infarction (TIMI) 0-1 grade in infarct-related artery (IRA) before PCI. TIMI of coronary artery was grade 3 in 76 patients and grade 2 in 16 patients after PCI. Two patients with eardiogenic shock died from ventricular fibrillation during PCI, and IRA was successfully reeanalizated in other 92 patients. The operation success rate of PCI was 97.9%. Six patients died from left heart failure postoperation. Intra-aortic balloon pump was performed to assist circulation in 26 patients with Killip Ⅲ, and the duration of counterpulsation was 78 to 154(98.3±34.5)h. Patients with multiple IRAs except 18 patients with 3 IRAs were received non-IRAs PCI 3 to 7 d after the operation. The fatality during hospitalization was 8.5% (8/94) in general, and the mortality of in-patients with heart function no less than Killip Ⅲ was 30.8%. The rate of bleeding complication needed blood transfusion was 3.3% (3/92). There was no major adverse cardiac event in survival patients during hospitalization. The rates of major adverse cardiac events at 30 and 180 d were 1.2% and 4.6%. The median LVEF was 43% (26% to 62% ) before discharge. Conclusion Direct PCI is a safe operation with high successful rate for patients over 80 years with AMI. Key words: Myocardial infarction;  Angioplasty; transluminal; percutaneous coronary; Elderly; Treatment effectiveness; Postoperative complications