Emergency coronary angiography in a 90-plus population – outcomes at 5-year follow-up

Abstract

Elderly people represent a vulnerable and increasing population presenting with acute coronary syndrome (ACS). Our goal was to evaluate a group of very old patients who underwent emergency coronary angiography (CA). We retrospectively analyzed a group of very old patients (≥90-year-old) who underwent emergency CA from 2008 to 2020. Survival and MACE [a composite of all-cause death, ischemic stroke, ACS or hospitalization for acute heart failure] were compared with an aged-matched control population with ACS not submitted to emergency CA. A total of 34 patients were enrolled, 56% female, median age of 92-year-old. Almost all patients had STE-ACS. In CA, 65% had multivessel disease and coronary intervention was performed in 71%. More than one-third evolved in Killip class III/IV and 70% had left ventricular dysfunction. Regarding mortality, 38% of patients died in the index event versus 25% in the aged-matched control group (p=0.319). During five years of follow-up, there was no significant difference in mortality between the two groups (Log-rank = 0.403) and more than 50% of patients died in two years. Comparing MACE occurrence, both groups were similar (Log-rank = 0.662), with more than 80% having at least one event in five years.  Very-old patients submitted to emergency CA had a high rate of multivessel disease and left ventricular dysfunction, in-hospital and follow-up mortality, and MACE. Compared to an aged-matched control group not submitted to emergency CA, they showed no survival or MACE benefit during a 5-year follow-up.