CARDIOVASCULAR JOURNAL OF AFRICA • Volume 25, No 1, January/February 2014
AFRICA
e9
by the trend towards improvement in the combined endpoint
of death, re-infarction and stroke at 30 days in the oldest (
>
75 years) patients. There were no significant differences in
complications, such as major haemorrhage, blood transfusion
or renal failure.
5
There are no studies on centenarian patients with acute
myocardial infarction (AMI) undergoing PCI. In the literature
there are only a few cases of patients older than 100 years with
STEMI who had successful PCI.
6,7
Because elderly patients
may have more calcified or totally occluded lesions, poor
left ventricular function and multiple co-morbid conditions,
physicians may hesitate to perform primary PCI in centenarian
patients. However each patient should be evaluated individually.
Certain measures can be applied in order to reduce
procedure-related complications in elderly patients who are
candidates for primary PCI when co-morbid conditions are
taken into consideration. Considering the increase in femoral
arteriosclerosis due to old age, the percutaneous transradial
approach can be selected because it may be less traumatic.
Careful use of anticoagulant and anti-aggregant drugs has a
very important role in reducing the risk of bleeding. Because
of the potential decline in renal function, hypo- or iso-osmolar
contrast agents should be used in centenarian patients with AMI
undergoing primary PCI.
Fig. 1.
The ECG obtained at admission showed right bundle branch block and ST-segment elevation in the anterior derivations.
Fig. 3.
An ECG obtained 90 minutes after PCI showing complete ST-segment resolution.
Fig. 2.
A. Selective left coronary angiogram obtained from the right anterior oblique cranial projection showing severe stenosis at
the proximal portion of the left anterior descending artery. B and C. The same projection taken during and after stenting.
A
B
C
