Combined Therapy with Chinese Medicine and Percutaneous Transradial Coronary Intervention for a Centenarian Patient with Acute Myocardial Infarction

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 mu g/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 (sic, 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.