Data supporting the use of the radial approach as the default strategy in octogenarians undergoing primary-PCI?

ABSTRACT

BACKGROUND: There is a significant increase in the number of octogenarians undergoing Primary Percutaneous Intervention (PPCI) for ST elevation myocardial infarction Objective: To analyze one year all cause mortality in octogenarians who are admitted with a STEMI and received PPCI in a tertiary cardiac centre in the UK, and to observe the impact of the mode of vascular access on mortality. METHODS: We reviewed registry records of consecutive STEMI patients(N=2951), admitted between 2005 and 2011.Kaplan-Meier and Cox regression analyses were used to compare mortality between OG and Age group (50-79) years. RESULTS: Of the total population, 8.1% (n=241, Mean age 85.3 yrs. (SD 3.4)) were OG of whom 53.5% were male. Use of femoral arterial access (63%) was significantly higher among OG (P=0.04) compared to radial route. In univariate analysis, event free survival was significantly lower in OG (log rank test, P=0.001) compared to other age group. All cause mortality was significantly higher among patients who had femoral arterial access compared to radial route (log rank test, P=0.03) in OG. In Cox regression analysis conventional risk factors femoral access remained significantly associated with one year all cause mortality (Beta-1.9(SE 0.9, P=0.04). CONCLUSION: In our analysis, OG who received PPCI for STEMI have disproportionately higher one year all cause mortality compared to younger age group. Use of femoral arterial access appears to be independently associated with this excess mortality. Radial access preferred to be the safer and prime option in this high risk population and warrants further investigations.