PCI May Be Safe for Selected Heart Attack Patients in Their 90s: Study
Netherlands: A study from a Dutch high-volume cardiac center, published in Clinical Cardiology, has found that percutaneous coronary intervention (PCI) could be performed safely in carefully selected patients in their 90s who experienced a heart attack. The findings support considering PCI in very elderly patients after individualized assessment of clinical status and procedural risks.
The proportion of octogenarians and nonagenarians presenting with acute coronary syndrome (ACS), including ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI), is increasing. However, very elderly patients remain underrepresented in clinical studies, leaving uncertainty regarding the benefits and risks of invasive treatment in this population. Researchers from the Department of Cardiology, Noordwest Ziekenhuisgroep Alkmaar, the Netherlands, and colleagues evaluated outcomes associated with an initial invasive strategy compared with optimal medical treatment (OMT).
The observational study included all consecutive patients older than 80 years admitted with STEMI or NSTEMI between 2020 and 2023. Patients were categorized according to whether they received an invasive approach or OMT. The researchers conducted multivariable-adjusted analyses separately among different age groups to assess mortality outcomes.
A total of 775 patients older than 80 years were included, of whom 81 were aged over 90 years. Nonagenarians were more frequently women and generally had lower hemoglobin and estimated glomerular filtration rate (eGFR) levels. They were also less likely to undergo coronary angiography or PCI compared with patients aged 80 to 90 years. Six patients underwent coronary artery bypass grafting (CABG), all of whom belonged to the 80–90-year age group.
The findings showed:
- No significant differences were observed in clinical complication rates between the age groups.
- An initial invasive strategy was associated with lower mortality at 1 year compared with OMT.
- The mortality benefit associated with invasive management was particularly evident among elderly patients with NSTEMI.
- Selected patients aged 90 years and older could undergo invasive treatment without an apparent increase in clinical complications.
Treatment decisions should be based on routine clinical factors, procedural risk, and shared decision-making rather than age alone. The study suggests that selected very elderly patients with ACS may still be considered for an invasive strategy.
The study has several limitations. Its observational design leaves the possibility of selection bias and residual confounding. Some clinical variables may also have been misclassified, while ejection fraction and peripheral arterial disease were unavailable. All-cause mortality was used as the primary endpoint because determining specific causes of death can be difficult in very elderly patients with multiple comorbidities.
The authors concluded that appropriately selected octogenarians and nonagenarians with ACS may benefit from invasive management without excess complications, particularly those aged 90 years and older with NSTEMI. They emphasized an individualized, patient-centered approach when deciding on invasive treatment.
Reference:
P. Siegers, C. E., Hoogervorst, Q. P., Dirksen, M., & M. Umans, A. W. (2026). Outcomes of an Interventional Approach in STEMI and NSTEMI All-Comer Octo and Nonagenarians. Clinical Cardiology, 49(9), e70463. https://doi.org/10.1002/clc.70463
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