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.