ASSESSMENT OF IN-HOSPITAL OUTCOMES OF PRIMARY PCI IN ELDERLY PATIENTS WITH ACUTE CORONARY SYNDROME

Abstract

Background: Acute Coronary Syndrome (ACS) is a spectrum of conditions associated with acute myocardial ischemia and includes unstable angina, non-ST-segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI). Percutaneous Coronary Intervention (PCI) is a cornerstone therapy for ACS, crucial for restoring coronary blood flow and reducing subsequent cardiovascular events. However, elderly patients present unique challenges due to higher comorbidities and procedural risks.

Objective: This study aimed to assess the in-hospital outcomes of primary PCI in elderly patients with ACS at Lady Reading Hospital, Peshawar, Pakistan.

Methods: This observational cohort study included 450 elderly patients (≥65 years) with ACS who underwent primary PCI from January 2021 to December 2022. Inclusion criteria were age ≥65 years, ACS diagnosis, and undergoing primary PCI. Exclusion criteria included prior coronary artery bypass grafting (CABG), refusal to consent, and non-cardiovascular terminal illnesses. Data were collected prospectively using standardized forms, documenting baseline characteristics, procedural details, and outcomes. Statistical analysis was performed using SPSS version 25.0, with continuous variables expressed as mean ± standard deviation (SD) or median (Interquartile Range [IQR]) and categorical variables as frequencies and percentages.

Results: The mean age of the patients was 70.4 years (SD: 4.8 years), with 62.2% male and 37.8% female. Major Adverse Cardiovascular Events (MACE) occurred in 22.2% of patients, with no significant difference between males and females (p=0.58). The mean left ventricular ejection fraction (LVEF) post-PCI was 48.5% (SD: 10.2%), with a slightly higher mean LVEF in males (49.0% vs. 47.6%, p=0.15). The median hospital stay was 5 days (IQR: 3-8 days). The incidence of complications included bleeding (6.7%) and stroke (2.2%), with no significant gender differences.

Conclusion: Elderly patients with ACS undergoing primary PCI at Lady Reading Hospital exhibit significant in-hospital outcomes, with a substantial incidence of MACE and notable differences in LVEF and hospital stay between genders. These findings highlight the need for tailored interventions and continuous monitoring to improve PCI outcomes in this high-risk population.