https://doi.org/10.1007/s00392-024-02526-y
1Universitätsklinikum Erlangen Medizinische Klinik 2 Erlangen, Deutschland; 2Friedrich-Alexander Universität Erlangen-Nürnberg Medizinische Klinik 2 Erlangen, Deutschland
Background
While the use of cardiac catheterization and interventional procedures in the very elderly often remains restricted in clinical practice, decisions about invasive procedures will be required increasingly often even in nonagenarians, given the demographic developments. We therefore analyzed intrahospital outcome and complication rates of cardiac catheterization and percutaneous coronary intervention in nonagenarians and evaluated the influence of pre-existing disorders, risk factors and frailty.
Methods
Retrospective single center analysis of 271 patients (144 men, 127 women) over 90 years of age (mean age 92±2 years) who underwent diagnostic cardiac catheterization and/or percutaneous coronary intervention (PCI) between 2005 and 2020. Data included basic patient characteristics, procedural aspects, preexisting disorders and cardiovascular risk factors, assessment of frailty at time of admission, intrahospital outcome (peri-and postprocedural complications like bleeding, arrhythmia, infections, stroke, MI, acute renal failure, delirium, death) as well as the rate of return to independent home care after hospital stay.
Results
The mean patient age was 92±2 years, 47% were women. The most frequent indications for cardiac catherization were stable angina (27%), acute coronary syndrome (ACS) (41%) and heart valve disease (32%). Cumulative intrahospital mortality was 6.1% after cardiac catheterization and 10.5% following PCI. In 44.6% of patients, complications occurred during or after a cardiac catheterization. Age, pre-existing cardiac or renal insufficiency and PCI were found to be predictive of procedural complications and mortality. In patients with ACS, the risk for complications was significantly higher (25.1% vs. 19.6%, P<0.001).
Significant frailty was present in 70 patients (25.9%), but was no independent predictor of complications or mortality (13.7% vs. 25.8%, p=0.3, 0.2% vs. 2.6% p=0.07). However, higher frailty scores were associated with prolonged hospital stay (8.3 days vs. 10.7 days) and a significantly increased likelihood for discharge to to a nursery home (4% vs. 8%, P<0.00001).
Conclusions
Cardiac catheterization in nongenarians has a non negligible risk of peri- or post-procedural complications and intrahospital mortality. While frailty was not an independent predictor of intrahospital complications and mortality, it was predictive for a longer hospital stay and need for care.