Effects of percutaneous coronary intervention in patients aged 70 years and over with chronic total occlusion lesions

Abstract

Objective To evaluate the clinical impact of percutaneous coronary intervention (PCI) on prognosis in elderly patients (≥70 years old) with coronary artery chronic total occlusion (CTO). Methods A total of 445 consecutive patients with a angiography-confirmed CTO lesions registered from January 2011 to December 2013 were divided into the elderly group (≥70 years) and the non-elderly group (<70 years). The primary endpoints measured were defined as the composite outcomes of hospitalization due to angina, re-infarction, heart failure, repeat re-vascularization, and cardiac death at 36 months follow-up. Results The elderly group included 200 patients (44.9%) and the non-elderly group included 245 patients (55.1%). During the follow-up, the proportions of coronary lesion were significantly higher in the elderly group with left main (LM) disease (45, 22.5%), three-vessel disease (166, 83.0%) and J-CTO score≥2 (64, 32.0%) than in the non-elderly group with diseases of LM, three-vessel, and J-CTO score ≥2〔(34, 13.9%); (180, 73.5%); (57, 23.3%), respectively〕(χ2=5.607, 5.782, 4.243; P=0.018, 0.016, 0.039). The ratio of the patients undergoing PCI-reperfusion therapy of CTO was higher in non-elderly group (109/275, 39.6%) than in elderly group (53/222, 23.9%) (χ2=13.891, P<0.001), while CTO PCI success rate was similar between the two groups (38 patients, 71.7% vs.90 patients, 82.6%, χ2=2.541, P=0.111). The elderly group versus non-elderly group showed that the 3-year cardiac mortality rate was 12.5% (25 patients) versus 3.3% (8 patients) (χ2=13.677, P<0.011), and the incidence rate of 3-year primary endpoint was 31.5% (63 patients) versus 22.9% (56 patients) (χ2=4.199, P=0.040). Among the elderly group, patients without CTOs re-vascularized by PCI had a greater tendency toward higher risk of hospitalization due to angina, re-infarction, heart failure, or repeat re-vascularization than patients with CTOs re-vascularized by PCI (34/149, 22.8% vs.3/33, 9.1%, χ2=3.143, P=0.076), while they had comparable incidence of 3-year cardiac death (19/149, 12.8% vs.5/33, 15.2%, χ2=0.007, P=0.933). Multivariate analysis revealed that after adjusting for baseline and procedure differences, LM combined with three vessel disease (OR=3.804, 95%CI: 1.274 to 11.356, P=0.017) remained an independent predictor for 3-year cardiac mortality in elderly patients with CTOs. Conclusions Elderly patients with CTO have mostly a serious coronary artery disease and a poor prognosis.Although CTO is re-vascularized by PCI, long-term clinical outcome seems not more to be improved in elderly patients with CTOs.LM combined with three-vessel disease might be an independent predictor for 3-year cardiac mortality in elderly CTO patients. Key words: Angioplasty, transluminal, percutaneous coronary; Coronary occlusion