CARDIOVASCULAR JOURNAL OF AFRICA • Volume 25, No 1, January/February 2014
e8
AFRICA
Case Report
Successful primary percutaneous coronary intervention
in a centenarian patient with acute myocardial infarction
Sukru Aksoy, Yalci̇
n Veli̇
bey, Bayram Koroglu, Meti̇
n Cagdas, Ozge Guzelburc, Nese Cam, Mehmet Eren
Abstract
A 104-year-old male patient was admitted to the emergency
department with chest pain. An electrocardiogram showed
ST-segment elevation in the anterior leads. He was immedi-
ately taken to the catheterisation laboratory for emergency
angiography, which showed thrombotic stenosis at the proxi-
mal portion of the left anterior descending (LAD) artery.
After intervention on the LAD lesion, successful balloon
angioplasty with stenting was performed. Here, we report a
case of successful primary percutaneous coronary interven-
tion (PCI) in a centenarian patient with acute myocardial
infarction. There are few clinical data on centenarian patients
with acute myocardial infarction undergoing primary PCI. To
the best of best our knowledge, this case is the first reported
in the literature where primary PCI was performed on a cente-
narian patient.
Keywords:
centenarian patient, acute myocardial infarction,
primary percutaneous coronary intervention
Submitted 11/9/12, accepted 16/1/14
Cardiovasc J Afr
2014;
25
: e8–e10
DOI: 10.5830/CVJA-2014-001
Primary percutaneous coronary intervention (PCI) is the best
reperfusion therapy for patients with ST-segment elevation
myocardial infarction (STMI).
1,2
In the literature, there are only a
few cases on centenarians with STMI undergoing primary PCI.
In this report, we present a case of successful primary PCI in a
104-year-old patient with acute myocardial infarction.
Case report
A 104-year-old male with a past history of hypertension and type
2 diabetes mellitus presented to the emergency department with
chest pain. His blood pressure and heart rate were 175/90 mmHg
and 110 beats per minute, respectively. The electrocardiogram
(ECG) showed anterior myocardial infarction with right bundle
branch block (Fig. 1).
With a diagnosis of acute anterior myocardial infarction and
after a loading dose of clopidogrel (300 mg) and acetylsalicylic
acid (300 mg), he was immediately taken to the catheterisation
laboratory for emergency angiography using the transfemoral
approach. Because of the potential decline in renal function in
elderly patients, we used iso-osmolar contrast agent.Angiography
demonstrated a 95% thrombotic stenosis at the proximal portion
of the left anterior descending (LAD) artery (Fig. 1), and plaques
in the circumflex (Cx) and right coronary (RCA) arteries without
significant stenosis.
We decided on primary intervention on the LAD lesion, and
successful balloon angioplasty (Simpass 2 × 15 mm, 12 atm,
AlviMedica, Istanbul, Turkey) with stenting (bare-metal stent,
Ephesus 3 × 18 mm, 12 atm, Medtronic, Mineapolis, USA)
was performed (Fig. 2). An ECG obtained 90 minutes after PCI
showed complete ST-segment resolution (Fig. 3).
No additional symptoms or PCI-related complications
occurred during hospitalisation and the patient was discharged
from hospital after six days without any symptoms. Transthoracic
echocardiography after four days was normal except for
concentric left ventricular hypertrophy and grade 1 diastolic
dysfunction. He had a normal global ejection fraction (55%)
without regional wall motion abnormalities.
Discussion
PCI is currently the treatment of choice for patients presenting
with ST-segment elevation myocardial infarction (STEMI).
Studies on primary PCI of elderly patients show a low rate of
procedure-related complications. Valente
et al
. suggested that
primary PCI in very old patients (
>
85 years) with STEMI
was safe and effective in reducing the rate of PCI failure in the
presence of a low Killip class on admission, whereas primary
PCI was unable to affect the poor prognosis for very old patients
with cardiogenic shock.
3
In another study by Sakai
et al
., they showed that aggressive
PCI in older patients improved the prognosis, and short door-to-
balloon time is an important parameter for a good prognosis.
4
The TRIANA study also suggested that primary PCI may offer
clinical advantages over fibrinolytic therapy, as manifested
Siyami Ersek Thoracic and Cardiovascular Surgery
Centre, Training and Research Hospital, Department of
Cardiology, Istanbul, Turkey
Sukru Aksoy, MD
Yalci̇
n Veli̇
bey, MD,
Bayram Koroglu, MD
Meti̇
n Cagdas, MD
Ozge Guzelburc, MD
Nese Cam, MD, PhD
Mehmet Eren, MD, PhD
