There are not enough clinical data about centenarians with acute
myocardial infarction (AMI) undergoing
percutaneous coronary intervention (PCI). A 104-year-old woman exhibited sharp
chest pain and severe
dyspnea. In routine examinations, her electrocardiogram showed 1-3 mm ST-segment elevation from V1 to V4 leads, the cardiac
enzymes were also elevated:
creatine kinase (CK)-MB was 45.7 U/L, and cardiac specific
troponin I was 40 microg/L. A two-dimensional echocardiography showed anteroseptal akinesia with severely depressed left ventricular function, 38% ejection fraction. She primarily refused to receive
percutaneous coronary intervention (PCI) considering her old age, and she was given a dual anti-platelet medications (low molecular
heparin and
frusemide). Three days later, due to continuously deteriorating
angina pectoris and
dyspnea, she was treated with PCI. A diagnostic percutaneous transradial coronary angiography revealed 95%
stenosis in the proximal left anterior descending artery (LAD) with 90%
stenosis at the origin of diagonal one. A
percutaneous coronary intervention for the LAD lesion was successfully performed, and the final angiogram showed a good coronary flow without residual
stenosis. The dual anti-platelet medications had to be ceased due to the upper gastrointestinal
bleeding after one week and
Tongguan Capsule (Chinese medicine composed with
Radix Astragali, Radix Salviae Miltiorrhiae, etc.) was administered continuously. The six-month follow-up displayed a high level quality of life for the centenarian woman with the absence of
angina pectoris and
dyspnea. The case reinforces the importance of PCI for very elderly patients with AMI even centenarian people and reveals the possibility that
Tongguan Capsule can be used to replace dual anti-platelet medication with the reduction of
bleeding complications.