Safety and efficacy of percutaneous coronary intervention in carefully selected very elderly patients with myocardial infaction at the Cardiovascular Center, E Hospital

Abstract

Background: ST-segment elevation myocardial infarction (STEMI) in very elderly patients (≥80 years) poses a significant challenge in clinical practice due to atypical symptoms, multiple comorbidities, and high mortality risk. Data regarding the characteristics and interventional outcomes of this population in Vietnam remain limited. Methods: A cross-sectional descriptive study was conducted on 129 patients aged ≥80 years diagnosed with STEMI who were indicated for percutaneous coronary intervention (PCI) at the Cardiovascular Center, E Hospital, from January 2023 to July 2025. Results: The mean age was 84.86 ± 3.2 years. Males accounted for 67.4%. The majority of patients presented with atypical symptoms or absence of chest pain (63.6%). The rate of late admission (>72 hours) was 39%. Common comorbidities included hypertension (73%), diabetes mellitus (62%), and respiratory diseases (54%). Coronary lesions were predominantly complex: 69% had multivessel disease, and 43.4% had type C lesions. Pre-procedural TIMI 0 flow was observed in 49.6% of cases, and thrombus aspiration was required in 55.8%. The rate of successful intervention and stable discharge reached 96.9%. There were 4 cases (3.1%) of mortality or discharge in critical condition due to cardiovascular complications and multiple organ failure. Conclusion: STEMI in very elderly patients frequently presents with subtle clinical manifestations and complex anatomical lesions. The strategy of percutaneous coronary intervention demonstrates high feasibility and safety, with a low in-hospital mortality rate in carefully selected patients.