Search

Introduction Owing to the ageing of the population, nonagenarian patients are increasingly present in catheterization laboratories, part of them with ST-segment elevation myocardial infarction (STEMI). Primary percutaneous coronary intervention (PCI) is the recommended reperfusion therapy in patients with STEMI, provided it can be performed promptly. However, elderly patients are usually excluded from clinical trials and few data are available about nonagenarians referred for primary PCI. Purpose The aim of the present study was to evaluate clinical characteristics and in-hospital outcomes of nonagenarians STEMI patients undergoing primary PCI. Methods We retrospectively analyzed clinical, angiographic and in-hospital outcomes of death, re-infarction and stroke of primary PCI in nonagenarian STEMI patients, included in the Brazilian PCI Registry (CENIC) between June 2006 and March 2016. Predictors of in-hospital mortality of this population were determined through multivariate analysis. Results Over a period of 10 years, 847 nonagenarians were enrolled in the CENIC Registry, and 252 presented with STEMI and underwent a primary PCI. The population was predominantly female (55.2%), with a median age of 92 years (interquartile range 4 years, maximum of 105 years) and 63.9% in Killip class I at admission. Median door-to-balloon time was 90±60 minutes. Double or triple-vessel disease was found in 63%. It was used 1.3 stent per patient, 8.9% drug-eluting stents. The femoral access route was preferred in 82.1% of patients and glycoprotein IIb/IIIa inhibitors was given to 9.9%. In-hospital mortality in the period was 10.7% and re-infarction occurred in 0.5%. No cases of stroke have been reported. The only predictor of hospital mortality was Killip class (OR 7.1, 95% CI 2.7–18.5, p Conclusion In a real-world setting, primary PCI in nonagenarian STEMI patients can be performed with good clinical outcomes and acceptable in-hospital mortality rate and must be recommended even in oldest-old age patients. Killip class was the only predictor of in-hospital mortality in this population. Funding Acknowledgement Type of funding source: None

INTRODUÇÃO: A insuficiência renal aguda (IRA) é uma complicação possível após intervenção coronária percutânea (ICP). O objetivo deste estudo foi avaliar a ocorrência e o impacto prognóstico da IRA pós-ICP em pacientes com infarto agudo do miocárdio com supradesnivelamento do segmento ST (IMCSST). MÉTODOS: Registro unicêntrico, que analisou a evolução hospitalar de 501 pacientes admitidos com IMCSST submetidos à ICP primária, de resgate ou tardia. Foram avaliados a incidência e os preditores de IRA pós-ICP. RESULTADOS: A idade média foi 60,7 ± 12,6 anos e 67% eram do gênero masculino. A população apresentava características de alto risco cardiovascular, sendo 30% diabéticos e 7,4% com doença renal crônica (DRC) preexistente. A artéria descendente anterior foi a principal artéria culpada (49,4%) e 15% dos pacientes se apresentaram em Killip III ou IV. A IRA ocorreu em 24,7% dos pacientes, que, quando comparados àqueles sem IRA, eram significativamente mais idosos, diabéticos, com DRC e insuficiência cardíaca, além de apresentarem maior elevação enzimática e menor fração de ejeção. A mortalidade hospitalar foi maior nos pacientes que desenvolveram IRA (29% vs. 4,8%; P < 0,01). Os preditores independentes de IRA foram idade > 76 anos, DRC prévia, Killip III ou IV, necessidade de cirurgia vascular ou transfusão sanguínea. CONCLUSÕES: A disfunção renal aguda após ICP no IMCSST foi uma complicação frequente e associada com aumento da mortalidade hospitalar. BACKGROUND: Acute renal failure (ARF) is a possible complication after percutaneous coronary intervention (PCI). The objective of this study was to evaluate the occurrence and prognostic impact of ARF after PCI in patients with ST segment elevation myocardial infarction (STEMI). METHODS: Single-center registry evaluating in-hospital outcomes of 501 patients admitted with STEMI undergoing primary, rescue or late PCI. The incidence and predictors of ARF after PCI were evaluated. RESULTS: Mean age was 60.7 ± 12.6 years and 67% were male. The population had high cardiovascular risk characteristics, with 30% of diabetics and 7.4% with preexisting chronic kidney disease (CKD). The left anterior descending artery was the culprit vessel in 49.4% of the cases and 15% of patients had Killip class III or IV. ARF was observed in 24.7% of patients, who were significantly older, had more diabetes, history of CKD or heart failure, had higher enzyme elevation and lower ejection fraction when compared to those without ARF. In-hospital mortality was higher in patients who developed ARF (29% vs. 4.8%; P < 0.01). Independent predictors of ARF were age > 76 years, previous CKD, Killip class III or IV, need of vascular surgery or blood transfusion. CONCLUSIONS: Acute renal failure after PCI in STEMI was a frequent complication and was associated with increased in-hospital mortality.

BackgroundAcute renal failure (ARF) is a possible complication after percutaneous coronary intervention (PCI). The objective of this study was to evaluate the occurrence and prognostic impact of ARF after PCI in patients with ST segment elevation myocardial infarction (STEMI).MethodsSingle-center registry evaluating in-hospital outcomes of 501 patients admitted with STEMI undergoing primary, rescue or late PCI. The incidence and predictors of ARF after PCI were evaluated.ResultsMean age was 60.7±12.6years and 67% were male. The populaton had high cardiovascular risk characteristics, with 30% of diabetics and 7.4% with preexisting chronic kidney disease (CKD). The left anterior descending artery was the culprit vessel in 49.4% of the cases and 15% of patients had Killip class III or IV. ARF was observed in 24.7% of patients, who were significantly older, had more diabetes, history of CKD or heart failure, had higher enzyme elevation and lower ejection fraction when compared to those without ARF. In-hospital mortality was higher in patients who developed ARF (29% vs. 4.8%; P76 years, previous CKD, Killip class III or IV, need of vascular surgery or blood transfusion.ConclusionsAcute renal failure after PCI in STEMI was a frequent complication and was associated with increased in-hospital mortality.