Temporal Trends and Outcomes of Superelderly Patients Undergoing Coronary Intervention: Insights From the J-PCI Registry.

Background

Percutaneous coronary intervention (PCI) is a widely available procedure for managing patients with and without acute myocardial infarction (AMI). Although age is a strong predictor of outcomes after PCI, contemporary data in patients with very advanced age are limited.

Objectives

The objectives of the study was to delineate the current practice patterns and clinical outcomes of PCI across septuagenarians, octogenarians, and nonagenarians.

Methods

The Japanese PCI is a nationwide registry covering most of the PCI procedures performed within the country. PCI procedures between 2019 and 2024 were included. Patients were divided into four age categories: 20 to 69, 70 to 79, 80 to 89, and 90 to 99 years, and further grouped according to the indications (AMI vs non-AMI). The trends and patterns of PCI procedures, in-hospital mortality, and complications across the age groups were assessed.

Results

A total of 1,454,940 PCI procedures, with 387,454 (26.6%) and 1,067,486 (73.4%) for AMI and non-AMI, were analyzed. During the study period, the mean age has consistently increased from 71.0 to 72.1 years in the entire study population. Nonagenarians accounted for 3.9% and 1.7% in the AMI and non-AMI cohorts in 2019 and 5.0% and 2.4% in 2024. In both cohorts, the higher age categories were associated with increased risks of in-hospital mortality and complications.

Conclusions

Our nationwide study demonstrated a consistent year-on-year increase in the age of patients undergoing PCI without reaching a plateau. Advanced age was strongly associated with poor outcomes, particularly in nonagenarians, reinforcing the need for shared decision-making in PCI in the oldest-old population.