Temporal Trends and Outcomes of Percutaneous Coronary Interventions in Nonagenarians

OBJECTIVES This study sought to assess temporal trends and outcomes of percutaneous coronary intervention (PCI) in nonagenarians. BACKGROUND With increasing life expectancy, nonagenarians requiring PCI are increasing even though outcomes data are limited. METHODS The National Inpatient Sample was used to identify all hospitalizations for PCI in patients aged >= 90 years from January 1, 2003, to December 31, 2014. The primary outcome was in-hospital mortality. RESULTS Nonagenarians (n = 69,271) constituted 0.9% of all PCI hospitalizations, increasing from 0.6% in 2003 to 2004 to 1.4% in 2013 to 2014 (P-trend < 0.001). From 2003-2004 to 2013-2014, the proportion of PCIs performed for ST-segment elevation myocardial infarction (STEMI) (23.1% to 30.9%) and non-ST-segment elevation acute coronary syndromes (49.6% to 52.6%) increased, whereas those for stable ischemic heart disease (SIHD) decreased (27.3% to 16.5%), respectively (p(trend) < 0.001 for all). Overall in-hospital mortality after PCI for STEMI, non-ST-segment elevation acute coronary syndromes, and SIHD were 16.4%, 4.2%, and 1.8%, respectively. After multivariable risk adjustment for demographics, comorbidities, and hospital-level characteristics, in-hospital mortality remained unchanged in STEMI (odds ratio: 1.04; 95% confidence interval: 0.98 to 1.11; p(trend )= 0.20) and non-ST-segment elevation acute coronary syndromes (odds ratio: 0.99; 95% confidence interval: 0.91 to 1.08; p(trend )0.82), but increased in SIHD (odds ratio: 1.21; 95% confidence interval: 1.01 to 1.44; P-trend 0.04) from 2003 to 2004 to 2013 to 2014. The rates of bleeding and vascular complications decreased or remained stable in all 3 subgroups, whereas risk-adjusted incidence of stroke increased in patients with STEMI or SIHD. CONCLUSIONS The rate of in-hospital mortality, major bleeding, vascular complications, and stroke after PCI in nonagenarians changed significantly from 2003 to 2014. This study provides a benchmark for discussion of PCI-related risks among physicians, patients, and families. (C) 2018 by the American College of Cardiology Foundation.