Northern Ireland Electronic Care Record Research Articles

ThP6.4 - Psoas Sarcopaenia as a Predictor of Mortality in Patients Over 65 with PR Bleeding: A Retrospective Case Controlled Study

Abstract Aims Sarcopaenia has been examined as a predictor for functional baseline and frailty in surgical patients and may predict mortality. The hypothesis of this study is that sarcopaenia is associated with increased risk of death after per rectal (PR) bleeding. Methods Patients over 65 who were admitted between January 2017 and December 2022, having had an episode of PR bleeding, that underwent cross sectional imaging were identified from the Southern health and social care trust database. Cross sectional imaging was accessed via PACS and total psoas area (TPA) calculated at the third lumbar vertebra by a radiology trainee and validated by a consultant radiologist. Clinical, mortality and demographic data was obtained from Northern Ireland Electronic Care Record (NIECR). Psoas muscle index (PMI) was then calculated by TPA and standardising for height in mm2/m2. Sarcopaenia was defined as PMI male < 545 mm2/m2 female < 385 mm2/m2. Results 77 Patients were included in this study. Patients were excluded based on the ability to standardise TPA for height. 27% (n 21) of patients were identified as sarcopaenic, 66% (n 14) of these patients have died. The median PMI showed differences between female mortality (490.44 mm2/m2) and non-mortality (559.49 mm2/m2) groups. Male patients also showed lower median PMI between mortality (599.79 mm2/m2) and non-mortality (643.05 mm2/m2 ) groups. Conclusions Sarcopaenia as a predictor for frailty is an important risk factor for all-cause mortality in PR bleeding. Cross-sectional imaging provides an opportunity to quantify risk as well as investigate aetiology for PR bleeding. Although radiation risk and cost effectiveness may limit use, it should be considered when imaging is available.

Clinical management and outcome of head and neck paragangliomas (HNPGLs): A single centre retrospective study.

Head and neck paragangliomas (HNPGLs) are rare, usually benign, slow-growing tumours arising from neural crest-derived tissue. Definitive management pathways for HNPGLs have yet to be clearly defined. To review our experience of the clinical features and management of these tumours and to analyse outcomes of different treatment modalities. Demographic and clinical data were obtained from The Northern Ireland Electronic Care Record (NIECR) as well from a prospectively maintained HNPGL database between January 2011 through December 2023. There were 87 patients; 50 females: 37 males with a mean age of 52.3 ± 14.2 years old (range 17-91 years old). 58.6% (n = 51) of patients had carotid body tumours, 25.2% (n = 22) glomus vagal tumours, 6.8% (n = 6) tumours in the middle ear, 2.2% (n = 2) in the parapharyngeal space and 1.1% (n = 1) in the sphenoid sinus. 5.7% (n = 5) of patients had multifocal disease. The mean tumour size at presentation was 3.2 ± 1.4 cm (range 0.5-6.9 cm). Pathogenic SDHD mutations were identified in 41.3% (n = 36), SDHB in 12.6% (n = 11), SDHC in 2.2% (n = 2) and SDHA in 1.1% (n = 1) of the patients. Overall treatment modalities included surgery alone in 51.7% (n = 45) of patients, radiotherapy in 14.9% (n = 13), observation in 28.7% (n = 25), and somatostatin analogue therapy with octreotide in 4.5% (n = 4) of patients. Factors associated with a significantly higher risk of recurrence included age over 60 years (p = .04), tumour size exceeding 2 cm (p = .03), positive SDHx variants (p = .01), and vagal and jugular tumours (p = .04). The majority of our patients underwent initial surgical intervention and achieved disease stability. Our results suggest that carefully selected asymptomatic or medically unfit patients can be safely observed provided lifelong surveillance is maintained. We advocate for the establishment of a UK and Ireland national HNPGL registry, to delineate optimal management strategies for these rare tumours and improve long term outcomes.

HPB P53 Readmission rate after laparoscopic cholecystectomy in a tertiary HPB Unit

Abstract Background Laparoscopic cholecystectomy comprises a large portion of benign biliary surgery, and is increasingly performed safely as a daycase. The aim of our study was to determine the rate of unplanned readmission to hospital or unscheduled contact with medical services following discharge after laparoscopic cholecystectomy, along with the reasons for seeking medical advice. Methods Patients were identified retrospectively from our HPB Unit's operative database. All patients were included (daycases and inpatients) who underwent laparoscopic cholecystectomy in our unit in the calendar year 2019. Patients were excluded if they also had a CBD Exploration, or if their operation was converted to an open procedure. All patients' records were reviewed in detail on the Northern Ireland Electronic Care Record to capture readmissions, A&E attendances and contact with Out of Hours GP service within 30 days of discharge from hospital following operation. Results 273 patients were admitted for planned cholecystectomy under 7 Consultant Surgeons. 257 had their operation completed laparoscopically (5.86% conversion rate). The overall daycase rate was 66%. 39 patients (15%) sought unplanned medical advice within 30 days of discharge. 15 patients (5.8%) contacted Out of Hours. A further 9 patients (3.5%) went to A&E. Most of these had pain or wound problems. There were 15 (5.8%) readmissions to hospital: 3 within 48 hours; with abdominal wall haematoma, constipation and pneumonia. The remainder (day 4-29) had mostly pain, vomiting or umbilical wound infection. Median length of stay was 3 days. Conclusions Our early readmission rate was low and in line with local guidance of <10%. Most patients seeking unplanned advice had pain or wound problems. Further work looking at counselling patients regarding postoperative pain and wound care may reduce the total readmission rate and unscheduled contact after discharge. Readmission was not dependent on the age or size of the patient, or on whether the operation was carried out as a daycase or inpatient.

683 Closed Loop Regional Audits on Quality Predictive Indicators for Renal Cell Carcinoma Management in Northern Ireland

Abstract Aim To conduct a full cycle Regional Audit in Northern Ireland to assess the ten Quality Predictive Indicators (QPI) in the management of Renal Cell Carcinoma (RCC) as per National Cancer Quality Steering Group (NCQSG) of NHS Scotland. Each cycle lasted for 6 months. Method QPIs were assessed in four major domains such as radiological, histological, surgical and pre-treatment performance indicators in the management of RCC. Using the Northern Ireland Electronic Care record, data were collected, recorded in MS Excel and analysed and arrived at conclusions. The results were compared with NHS Scotland RCC audit reports published in August 2019 and October 2022. Results In audit cycle 1, NCGSQ targets of quality prediction was achieved in 3 QPIs (Nephron Sparing Surgery, Trifecta rate and 30/90 mortality rate) among the 10 QPIs. In Audit Cycle 2, additional 4 NCGSQ targets were achieved namely- pre-treatment CT/MRI, Histodiagnosis in cryotherapy, histodiagnosis in chemotherapy and MDT discussion. Conclusions There has been significant improvement in all QPIs in the management of RCC in Northern Ireland during the audited period. We have achieved NCGSQ quality performance indicator targets in 7 among the 10 QPIs that were audited. Further interventions may be required to achieve targets in QPIs such as Leibovich scoring, pre-treatment TNM staging and prognostic scoring in metastatic RCC.

679 Regional Closed Loop Audits on Quality Predictive Indicators of Renal Cell Carcinoma Management in Northern Ireland

Abstract Aim To conduct a full cycle Regional Audit in Northern Ireland to assess the ten Quality Predictive Indicators (QPI) in the management of Renal Cell Carcinoma (RCC) as per National Cancer Quality Steering Group (NCQSG) of NHS Scotland. Each cycle lasted for 6 months. Method QPIs were assessed in four major domains such as radiological, histological, surgical and pre-treatment performance indicators in the management of RCC. Using the Northern Ireland Electronic Care record, data were collected, recorded in MS Excel and analysed and arrived at conclusions. The results were compared with NHS Scotland RCC audit reports published in August 2019 and October 2022. Results In audit cycle 1, NCGSQ targets of quality prediction was achieved in 3 QPIs (Nephron Sparing Surgery, Trifecta rate and 30/90 mortality rate) among the 10 QPIs. In Audit Cycle 2, additional 4 NCGSQ targets were achieved namely- pre-treatment CT/MRI, Histodiagnosis in cryotherapy, histodiagnosis in chemotherapy and MDT discussion. Conclusions There has been significant improvement in all QPIs in the management of Renal Cell Carcinoma in Northern Ireland during the audited period. We have achieved NCGSQ quality performance indicator targets in 7 among the 10 QPIs that were audited. Further interventions may be required to achieve targets in QPIs such as Leibovich scoring, pre-treatment TNM staging and prognostic scoring in metastatic RCC.

Are Patients With Morbid Obesity at Increased Risk of Pulmonary Embolism or Proximal Deep Vein Thrombosis After Lower Limb Arthroplasty? A Large-database Study.

Whether increased BMI is associated with an increased risk of venous thromboembolism (VTE) is controversial. Despite this, BMI > 40 kg/m 2 remains a common cutoff for lower limb arthroplasty eligibility. Current United Kingdom national guidelines list obesity as a risk factor for VTE, but these are based on evidence that has largely failed to differentiate between potentially minor (distal deep vein thrombosis [DVT]), and more harmful (pulmonary embolism [PE] and proximal DVT) diagnoses. Determining the association between BMI and the risk of clinically important VTE is needed to improve the utility of national risk stratification tools. (1) In patients undergoing lower limb arthroplasty, is BMI 40 kg/m 2 or higher (morbid obesity) associated with an increased risk of PE or proximal DVT within 90 days of surgery, compared with patients with BMI less than 40 kg/m 2 ? (2) What proportion of investigations ordered for PE and proximal DVT were positive in patients with morbid obesity who underwent lower limb arthroplasty compared with those with BMI less than 40 kg/m 2 ? Data were collected retrospectively from the Northern Ireland Electronic Care Record, a national database recording patient demographics, diagnoses, encounters, and clinical correspondence. Between January 2016 and December 2020, 10,217 primary joint arthroplasties were performed. Of those, 21% (2184 joints) were excluded; 2183 were in patients with multiple arthroplasties and one had no recorded BMI. All 8033 remaining joints were eligible for inclusion, 52% of which (4184) were THAs, 44% (3494) were TKAs, and 4% (355) were unicompartmental knee arthroplasties; all patients had 90 days of follow-up. The Wells score was used to guide the investigations. Indications for CT pulmonary angiography for suspected PE included pleuritic chest pain, reduced oxygen saturations, dyspnea, or hemoptysis. Indications for ultrasound scans for suspected proximal DVT included leg swelling, pain, warmth, or erythema. Distal DVTs were recorded as negative scans because we do not treat them with modified anticoagulation. The division of categories was set at BMI 40 kg/m 2 , a common clinical cutoff used in surgical eligibility algorithms. Patients were grouped according to WHO BMI categories to assess for the following confounding variables: sex, age, American Society of Anesthesiologists grade, joint replaced, VTE prophylaxis, grade of operative surgeon, and implant cement status. We found no increase in the odds of PE or proximal DVT in any WHO BMI category. When comparing patients with BMI less than 40 kg/m 2 with those with a BMI of 40 kg/m 2 or higher, there was no difference in the odds of PE (0.8% [58 of 7506] versus 0.8% [four of 527]; OR 1.0 [95% CI 0.4 to 2.8]; p > 0.99) or proximal DVT (0.4% [33 of 7506] versus 0.2% [one of 527]; OR 2.3 [95% CI 0.3 to 17.0]; p = 0.72). Of those who received diagnostic imaging, 21% (59 of 276) of CT pulmonary angiograms and 4% (34 of 718) of ultrasounds were positive for patients with BMI less than 40 kg/m 2 compared with 14% (four of 29; OR 1.6 [95% CI 0.6 to 4.5]; p = 0.47) and 2% (one of 57; OR 2.7 [95% CI 0.4 to 18.6]; p = 0.51) for patients with BMI 40 kg/m 2 or higher. There was no difference in the percentage of CT pulmonary angiograms ordered (4% [276 of 7506] versus 5% [29 of 527]; OR 0.7 [95% CI 0.5 to 1.0]; p = 0.07) or ultrasounds ordered (10% [718 of 7506] versus 11% [57 of 527]; OR 0.9 [95% CI 0.7 to 1.2]; p = 0.49) for BMI less than 40 kg/m 2 and BMI 40 kg/m 2 or higher. Increased BMI should not preclude individuals from lower limb arthroplasty based on suspected risk of clinically important VTE. National VTE risk stratification tools should be based on evidence assessing clinically relevant VTE (specifically, proximal DVT, PE, or death of thromboembolism) only. Level III, therapeutic study.

Safety Evaluation of an Expedited Omalizumab Home Self-Administration Pathway.

IntroductionThe Northern Ireland Regional Immunology Service (NIRIS) has developed an expedited omalizumab home self-administration pathway to reduce face-to-face clinic attendance during the coronavirus disease 2019 (COVID-19) pandemic. This audit evaluates the safety of this pathway with a particular focus on anaphylaxis.ObjectivesThis study aimed to retrospectively audit the records of 39 patients undertaking expedited home self-administration at NIRIS for complications, particularly emergency department attendance for anaphylaxis. The target was for 100% of patients to complete a six-month course without experiencing anaphylaxis related to omalizumab administration.Materials and methodsA total of 39 records of patients who underwent expedited omalizumab self-administration were audited by a single reviewer. They were prospectively collected between March 2020 and August 2021. Clinical data were collected from the Northern Ireland Electronic Care Record (NIECR).ResultsHundred percent of patients were in the process of completing or had completed a six-dose course without anaphylaxis. During the course of omalizumab, 7.6% of patients attended the emergency department. Zero percent of patients have experienced anaphylaxis triggered by omalizumab. The target of 100% patients completing the expedited pathway without omalizumab-related anaphylaxis was met.ConclusionHome self-administration of omalizumab is preferred by patients and clinicians for reducing expense, travel, and unnecessary clinical contact during the COVID-19 pandemic. An expedited omalizumab home self-administration training pathway appears to be safe in a population of Northern Irish patients with chronic spontaneous urticaria (CSU). More research is needed to determine whether the expedited pathway should become the standard of care post-pandemic

Suture-Button Versus Syndesmotic Screw Fixation of Ankle Fractures: A Comparative Retrospective Review Over One Year

BackgroundSyndesmotic fixation is essential in the management of unstable ankle fractures with syndesmotic disruption. It can be achieved either by rigid fixation with screws or dynamic fixation with suture-button devices. Syndesmosis screws are considered the gold standard for the stabilisation and fixation of distal tibiofibular syndesmotic injuries. We use both types of devices in our unit for the stabilisation of syndesmotic injuries. In our department, Arthrex TightRope® (Arthrex, Naples, FL) is the preferred suture-button device for the dynamic fixation of distal tibiofibular syndesmosis. Some studies have reported better outcomes with the use of suture-button devices. In this study, we aim to compare the outcomes with the use of both these devices.MethodologyThis retrospective cohort study was conducted from 1 June 2019 until 31 May 2020 which included all patients who underwent syndesmotic fixation. Data were collected from the Northern Ireland Electronic Care Record and the Northern Ireland Picture Archiving and Communication System. Primary outcomes included reoperation rates due to failure of syndesmotic hardware. Secondary outcomes included the comparison of complications (e.g. infection, wound problems, or loss of reduction) radiographic fixation/stability, duration of follow-up, and significant ongoing symptoms at the time of discharge from the clinic.ResultsA total of 53 patients underwent syndesmotic stabilisation during this period. In total, 34 patients underwent fixation with TightRope and 19 underwent syndesmotic screw fixation. Three patients (9%) had reoperation due to any cause in the TightRope group compared to four patients (21%) in the syndesmotic screw group. All four patients in the syndesmotic screws group underwent implant removal due to failure or symptoms due to implant. Only one patient (3%) in the TightRope group underwent implant removal due to ongoing pain [the other two (6%) patients included one with lateral ankle abscess and one with long distal fibula screws, both unrelated to the use of TightRope and TightRope left in situ at reoperation]. Rediastasis was reported in one (5.2%) patient with syndesmotic screws. The median duration of follow-up was 82 days in the syndesmotic screw group compared to 77.5 days in the TightRope group.ConclusionsBased on our data, we report a lower incidence of implant-related problems and the need for implant removal with the use of TightRope. Quicker return to weight-bearing and slightly better radiographic stabilisation were noted as well. Our study has its limitations in terms of a small number of patients and the absence of functional outcomes as these were not routinely recorded at the time of discharge from the clinic.

Tubulointerstitial nephritis and uveitis in Northern Ireland

ObjectivesThis paper looks at patients with a diagnosis of tubulointerstitial nephritis and uveitis (TINU) presenting to the Northern Ireland regional adult and paediatric uveitis service in the Belfast Health and Social Care Trust. The demographic distribution, treatment required and the visual and renal outcomes of these patients are documented.MethodsData were collected retrospectively on 24 patients with TINU using the Northern Ireland Electronic Care Record, central pathology records alongside the adult and paediatric uveitis databases from 2011 to 2021. Patients were categorised into two groups using the Mandeville classification system. Standard Uveitis Nomenclature (SUN) was used to classify the uveitis.ResultsThe population prevalence is at least 12.6 cases per million based on a population of 1.9 million. Nineteen of 24 cases were definite TINU and five of 24 probable. Seventeen out of 24 had biopsy-positive TIN, all of which met all of the Mandeville clinical diagnostic features required for a definite diagnosis. All but one presented with acute bilateral anterior uveitis. The paediatric cases ranged from age 12 to 18 at age of onset with a mean age of 14. Of the 18 adult onset cases, the age ranged from 20 to 76 years. The mean age of onset for the adult cases was 53 years. Of these patients 71% were female; 42% required second-line immunosuppression for ocular disease. Visual acuity was maintained. Follow-up time ranged from 3 months to 16 years. No patient developed long-term renal impairment.ConclusionsTINU is a cause of uveitis in both the paediatric and adult populations. In Northern Ireland average age with TINU was older than much of the published literature. Long-term immunosuppression for uveitis may be required as ongoing ocular, rather than renal inflammation seemed to require treatment.

EPS2.02 Characterisation of liver USS findings in pre-school children with cystic fibrosis

Objectives: European consensus guidelines recommend annual screening for cystic fibrosis-related liver disease (CFLD) with annual clinical, biochemical and ultrasound (USS) evaluation. Abdominal USS is initiated from age 5 in many centres across the UK;however, it has been our practice to initiate from age 2. In this study we aim to determine the incidence of liver abnormalities in young children as recent reduced access to radiological services due to the COVID-19 pandemic has prompted us to re-evaluate our practice. Methods: We retrospectively evaluated abdominal USS reports of consecutive children aged 2–5 years with confirmed diagnosis of CF attending the NI regional CF centre between 2012 and 2020, along with relevant demographic and clinical data and liver function tests. All data was retrieved from the Northern Ireland Electronic Care record (NIECR). Results: Seventy 2–5-year-olds underwent a total of 199 scans between 2012 and 2020. In 2-year-olds, 43% of scans detected an abnormality, increasing to 70% in 5-year-olds, RR 1.61, 95% CI 1.03, 2.65, p = 0.03. 107 (53.4%) scans had one or more abnormality reported. Increased echogenicity of liver and/or pancreas was the most common abnormality identified in 72 of 107 scans (67.2%);hepatomegaly in 46 (42.9%);coarse heterogeneous echotexture in 24 (22.4%);increased periportal echogenicity in 6 (5.6%) and other incidental findings in 10 (9.3%) of scans, including cholelithiasis, splenic cyst, renal scarring, renal stones, and micro gallbladder. Conclusion: Abnormalities are present in over half of abdominal ultrasound scans in 2–5-year-olds. Increased echogenicity, liver enlargement and coarsened echotexture are indicative of hepatic steatosis, which has unclear significance in this age group. Longitudinal studies are needed to determine the role of early USS in detection of liver disease, and whether any particular abnormalities may identify those at risk of development of severe CFLD.

2898 200 Cases of Endometrial Cancer – 10 Year Outcomes

Study Objective To investigate the outcomes of 200 women with early stage Endometrial Cancer managed at a District General Hospital over a 10 year period. Design Retrospective audit of 200 patients with confirmed endometrial cancer, within one Trust in Northern Ireland, from 2009-2018. Information was collected from Northern Ireland Electronic Care Record, and subsequently analyzed using Microsoft Excel. Setting Southern Health and Social Care Trust, Northern Ireland Patients or Participants 200 patients were identified from one surgeon's database of recorded cases Interventions N/A Measurements and Main Results 88% were overweight or obese, 74% presented with postmenopausal bleeding, 54% women underwent total laparoscopic hysterectomy (TLH), 28.5% abdominal hysterectomy, 13.5% vaginal hysterectomy (VH), 3.5% Laparoscopic assisted vaginal hysterectomy (LAVH), 0.5% transcervical resection and mirena. Overall complication rate was 5% for both laparoscopic and abdominal hysterectomy groups, 1% for vaginal and LAVH. Breakdown of specific complications available. Conversion rate from laparoscopic to open hysterectomy was 3.6%. Pre-operative histology compared with hysterectomy specimen matched in 78% cases. 3% were significantly upgraded from low to high grade. Pre-operative radiological staging matched the hysterectomy specimen in 69% of cases. 6% were upstaged from Stage 1, to Stage 2 or 3. Overall confirmed recurrence rate was 2.5%. None were detected through standard follow-up pathways. Conclusion This study supports the strong association between high BMI and endometrial cancer. Despite obesity presenting significant surgical challenges, complication rates are low considering the patient demographic. The shortest median length of stay was with vaginal and laparoscopic hysterectomy. Preoperative grading and staging are relatively accurate in our department. Confirmed recurrence rates are low, although a significant proportion of patients are still in follow-up. Clinical follow-up is not useful in detecting recurrence in the majority of patients, which supports a Self Directed Aftercare approach in the majority of early stage endometrial cancers.

59 Real world TAVI outcome and prognostication: a retrospective review of a single centre experience

Introduction Trans-catheter aortic valve implantation (TAVI) is now an established treatment option for patients with severe symptomatic aortic stenosis who are at high or inoperable risk for surgical aortic valve replacement. Most of the established data are from studies of patients meeting strict inclusion and exclusion criteria. We present the complete experience from our centre including 1, 3 and 5 year outcomes and identify adverse prognostic factors. Method A retrospective analysis of consecutive TAVI procedures within our centre was performed from 2008 to 2014 utilising the National Institute of Cardiovascular Outcomes (NICOR) database. Patient and procedural data were obtained with corroboration of outcome using the Northern Ireland Electronic Care Record (NIECR) system. Statistical analysis was performed using SPSS version 21. Kaplan-Meier survival curves were drawn to assess survival at 30 days, 1, 3 and 5 years. For predictors of outcome Cox regression was performed with a univariate analysis to determine significance (p Results From February 2008 to December 2014, 414 TAVI procedures were performed. Outcome data was available for 408 patients. The Medtronic Corevalve prosthesis was predominantly implanted (63.2%) with the majority of procedures performed under local anaesthesia (91.0%) via the femoral approach (90.7%). Significant (moderate or greater) aortic regurgitation (AR) assessed by trans-thoracic echocardiography occurred in 4.4%, with 13.2% of patients requiring permanent pacemaker implantation. Survival was 96.1% at 30 days, 85.5% at 1 year, 72.7% at 3 years and 49.2% at 5 years with no significant difference according to year of implantation (Figure 1). Univariate predictors of 1 year mortality were Logistic Euroscore (LES) >24 (HR 2.1; 95% CI 1.1–3.8, p = 0.02), moderate or greater AR (HR 4.5; 95% CI 2.0–10.1, p 150 ummol/L (HR 4.0; 95% CI 2.3–6.9, p 24, creatinine >150, atrial fibrillation, left ventricular dysfunction and AR. Multivariate analysis confirmed creatinine as the only independent predictor of 3 year mortality (HR 2.9; 95% CI 1.7–5.0, p Conclusion This all-comers TAVI experience demonstrates encouraging results that are consistent with published data. Baseline renal function was the most powerful predictor of 1 and 3 year mortality with paravalvular regurgitation proving the most significant procedural marker of adverse outcome.

5 Temporal changes in percutaneous coronary intervention in the elderly: Abstract 5 Table 1

Introduction We previously reported PCI outcomes in the elderly (age ≥80) over the 2 year period 2003–4. Since then the unit has introduced routine primary PCI and TAVI. This re-audit assessed the impact of these changes on our practice and outcomes. Methods All elderly PCI patients in 2014 were identified using the trust PCI database and 90 day outcomes obtained from the Northern Ireland electronic care record. Results There were 257 PCIs in 241 elderly patients; 90 day outcome data was available for 239 patients. Demographics, presentation and outcomes are compared with the previous audit (which reported in-hospital and 1 year outcomes) in this Table 1. In 2014 15.1% of our PCIs were in elderly patients (compared with 10.4% nationally, BCIS 2013 audit figures). This represents a 6 fold increase in our elderly PCI rate (2.5% vs 15.1%) over 10 years. This has been driven by a substantial increase in AMI angioplasty in the elderly (1.8% vs 33.5% of elderly PCIs). In spite of this high risk population, in-hospital mortality remained relatively low. Mortality for ≥ 80 year old patients was 15/257 (5.8%) compared with 33/1441 (2.3%) for those Conclusion The significant increase in elderly PCI observed over this 10 year period appears to be justified by outcome measures.