Contemporary PCI Outcomes in the Elderly – A Single Centre Experience

Abstract

Introduction: Despite increasing prevalence of cardiovascular disease in the elderly, they are often excluded from clinical revascularisation trials. Data on outcomes of contemporary PCI in the elderly is lacking. Objectives: To describe the clinical characteristics and outcomes of elderly patients undergoing PCI at St Vincent's Hospital Melbourne. Methods: We analysed 140 patients >80 years old who underwent PCI between September 2012 and December 2015, representing 9.7% of total PCIs performed over the same period of time. Clinical and procedural characteristics, in-hospital and 30-day outcomes are described. Results: The cohort had a mean age of 82.9±2.7 years and 59% were males. Medical comorbidities were diabetes (37%), previous MI (9%), cerebrovascular disease (12%) and peripheral vascular disease (10%). Mean baseline creatinine was 100±40 mmol/L. Presentation with STEMI, NSTEMI, and unstable angina were 10%, 32% and 57% respectively. Cardiogenic shock was present in 6%; 1 out of hospital cardiac arrest; 62% had multivessel disease. Procedural success rate was 99% with mean 1.5 stents per patient deployed and 80% received drug-eluting stents. 4% received glycoprotein IIb/IIIa inhibitors; 41% femoral approach; 9% suffered from periprocedural bleeding complications; and 4% developed contrast-induced nephropathy. In-hospital mortality was 3% (2 cardiac deaths, 1 anuric renal failure, 1 haemorrhagic stroke). There was no additional mortality or MACE event at 30 days. Conclusion: In a selected group of elderly patients, high PCI success rates can be achieved with favourable short-term outcomes. Further studies are warranted to examine the long-term outcomes of management strategies in this population.