Optimal management of coronary artery disease in very old patients – over eighty years of age – remains unclear due to the absence of large randomized trials in this high-risk subgroup and the benefit/risk ratio of percutaneous coronary intervention (PCI) is difficult to assess in clinical practice.

The aim of our study was to evaluate the in-hospital and mid- term outcomes of PCI in octogenarians in a retrospective registry including patients with clinical presentation ranging from stable angina refractory to medical treatment to cardiogenic shock and to identify the criteria of our decision-making process.

Between 2003 and 2009, 582 octogenarians were admitted for coronary events. 336 patients benefit from a coronary angiogram; PCI was performed in 232. Mean age was 82±2.6 and 45% were women. The procedures were unplanned due to ST elevation myocardial infarction (STEMI) (32.8%), cardiogenic shock complicating STEMI (9%), and non ST elevation myocardial infarction (NSTEMI) (30.6%). 36.6% of procedures were performed for stable angina refractory to optimal medical therapy. Radial access was used in 87% of cases. Primary success rate was 93%. Three criteria for invasive strategy refusal were identified in our clinical practice: renal insufficiency, anemia and cognitive disorders. Rates of in hospital mortality were respectively 12.5% in all patients; 85.7% in cardiogenic shock, 14.5% in patients with STEMI without shock, 2.8% in those with NSTEMI and 2.35% in patients with stable angina. The overall three years mortality rate is significantly lower with PCI than with conservative strategy (35% versus 58%, p = 0,0002).

In octogenarians, in hospital outcome is strongly related to the clinical presentation at admission. PCI display significantly beneficial effects on mid- term overall mortality in these old patients provided an easy to do selection regards three pitfalls: renal dysfunction, anemia and cognitive impairment.