A Very Elderly Woman Experiencing Two Episodes of Acute Myocardial Infarction Treated by Percutaneous Coronary Intervention: A Case Report and Literature Review

• Main Authors: Li-Chin Sung, Ji-Hung Wang
• Format: Article
• Language: English
• Published: Taiwan Society of Geriatric Emergency and Critical Medicine (TSGECM) 2010-09-01
• Series: International Journal of Gerontology
• Subjects: elderly; myocardial infarction; percutaneous transluminal coronary angioplasty
• Online Access: http://www.sciencedirect.com/science/article/pii/S1873959810700399

Advanced age is associated with poor outcome among patients with acute myocardial infarction (AMI). It appears that elderly patients are treated more conservatively because of multiple comorbidities and higher risk of further invasive therapy. Reperfusion therapy for AMI may improve survival, and previous studies have shown that patients receiving percutaneous coronary intervention (PCI) have better clinical outcomes than those given thrombolytic therapy. We report our experience with a 96-year-old woman with anteroseptal wall ST-segment elevation myocardial infarction successfully treated with primary PCI. One stent was implanted in the left anterior descending artery occlusive lesion. The patient survived and was discharged from the hospital 7 days later. She received optimal medical therapy and had no major adverse cardiac events within 1 year. Unfortunately, the patient had non-ST-segment elevation myocardial infarction 18 months later. We discussed with her family about the risk/benefit ratio of PCI, and they agreed with the procedure. We performed PCI successfully and the patient was discharged 5 days later. No major adverse cardiac events occurred within 4 months. In very elderly patients without multiple comorbidities, PCI is safe for AMI and effective in shortening hospital stay, reducing in-hospital and short-term mortality. We also discuss our strategy for this very elderly patient and the present therapy for AMI in nonagenarians.