Does specific interventional risk scoring better predict mortality than comorbidity in nonagenerians undergoing coronary angioplasty?

BACKGROUND: Preliminary study to assess the risk profile and outcomes of patients aged over 90years at the time of percutaneous coronary intervention. METHODS: A database search was performed to identify patients 90years or over at the time of percutaneous coronary intervention. Risk profile scores (Charlson Comorbidity Index, SYNTAX, Logistic clinical SYNTAX, New York PTCA score and frailty indices) were evaluated on 24 consecutive patients in order to determine the best predictor for survival. Between both groups (survivors and non-survivors) unpaired Student's t-test was used to determine statistical significance. RESULTS: The New York PTCA score was significantly higher in those patients that died in hospital (n=5) when compared to those who survived to discharge (n=19) (NY PTCA score of 20.9±5.4 vs. 4.5±0.8, p<0.001) and this was also seen with mortality at 12months. The level of co-morbidity (Charlson index) was similar in patients who died in hospital (n=5) compared with those who survived to discharge (n=19, Charlson comorbidity index of 3.4±0.7 vs.3.9±0.6, p=0.70). This trend was also observed at 1year. The average level of frailty (by the CSHA Clinical Frailty Scale), SYNTAX score and logistic clinical SYNTAX were not significantly different between the two groups both at discharge and at 12months. Choosing an arbitrary New York PTCA score of 9%, nearly two thirds of patients above this level died, whereas no patient below this level of risk died in hospital. CONCLUSION: This small observational study found that nonagenarians who underwent PCI had relatively low comorbidity and SYNTAX scores. The specific coronary intervention (New York PTCA) risk score appears to have more predictive power in this small group of patients than the other three scores. Crucially, the factors that determine risk by New York PTCA score - haemodynamic instability, shock, pulmonary oedema, renal failure, etc. - are commonly encompassed by an "end-of-bed" assessment of the patient and these patients that pass this test ought not to be denied PCI on the basis of their advanced years.