The purpose of our study was to evaluate the use of
bleeding-avoidance strategies (BAS) and risk-adjusted
bleeding over time in patients ≥80 years of age undergoing primary
percutaneous coronary intervention (PCI) for
ST-segment elevation myocardial infarction. We analyzed data from the CathPCI Registry from July 1, 2006 through June 30, 2009. Patients were included if they were ≥80 years old, presented with
ST-segment elevation myocardial infarction, and underwent primary PCI. We evaluated trends in use of BAS (
direct thrombin inhibitors,
vascular closure devices, and radial access) and risk-adjusted
bleeding over time. Of 10,469 patients ≥80 years old undergoing primary PCI, 1,002, (9.6%) developed a
bleeding complication. Use of
direct thrombin inhibitors and
vascular closure devices increased over time (12.8% to 24.9% and 29.2% to 32.7%, p <0.01 and <0.05 for trends, respectively). Radial access was extremely uncommon (<1%) and did not change over the course of the study. In multivariable analyses, use of BAS was associated with lower
bleeding. However, over the course of the study period, overall risk-adjusted
bleeding did not decrease significantly (9.9% to 9.4%, p = 0.14 for trend). In conclusion, patients ≥80 years old undergoing primary PCI are at high risk of
bleeding, and despite significant increases in use of BAS, the overall rate of
bleeding complications remains high.