(dailyRx)
As healthcare has improved, it’s no longer uncommon for patients to live past age 90. Guidelines do not currently address older heart attack patients receiving a stent to prop open a blocked artery.
However, new findings suggest that seniors over the age of 90 who receive a coronary stent have “reasonable outcomes” and should be considered for such treatments.
Dr. David M. Larson, lead author of the study, chairman of the emergency department at Ridgeview Medical Center and physician researcher with the Minneapolis Heart Institute Foundation, explained that cardiologists are uncertain when it comes to decision-making for this elderly population.
He said that previously few solutions were offered outside of care to make older senior patients comfortable, but that doctors are seeing an increase in the number of patients in the over 90 age range arriving at hospital emergency rooms. The number of individuals over the age of 90 is expected to quadruple in the U.S. by 2050.
Researchers used a prospective observational registry to follow 3,367 patients over the age of 90 who had experienced a ST segment elevation myocardial infarction (STEMI), a heart attack that stems from total blockage of a coronary artery, between April 2003 and October 2011.
Percutaneous coronary intervention (PCI), comprised of angioplasty and stent placement to widen clogged arteries, was performed in 50 of those patients. Researchers found that 12.1 percent of patients who received the intervention died in the hospital, and 15.2 percent did not survive 30 days.
There were no hospital readmissions for cardiovascular problems within a month of the procedure, however, an important measurement. Most patients also were able to return to their previous home or assisted living facility following PCI.
“Taking into consideration that these outcomes are based on registry data, these outcomes demonstrate that PCI may be an excellent option for STEMI patients who are 90 year olds or older,” Dr. Larson said.
Investigators also concluded that using PCI to treat STEMI in older populations may be cost effective because if the artery is not opened, most of the patients develop heart failure or die.
The research was presented Sunday at the American College of Cardiology’s annual scientific sessions.
Coronary artery disease is the leading cause of death in the United States and in the rest of the world. Estimates point to almost one half of all middle aged men and one third of all middle aged women in the United States developing some form of CAD. The primary symptom of angina, commonly known as chest pain, occurs when the artery is almost completely blocked.
Plaques made up of cholesterol and fibrous tissue lodge in the walls of the arteries that supply blood to the heart. Slow growth of the plaques can cause chest pain as they restrict blood flow to the heart muscle, and complete closure or rupture of the plaque can cause a myocardial infarction, commonly known as a heart attack, with resulting disability or death. CAD is primarily a disease of diet and habits, with the greatest risk factors coming from smoking, high blood pressure, high cholesterol, and diabetes.