Percutaneous Coronary Intervention In Octogenarians Research Articles

Comparing outcomes between coronary artery bypass grafting and percutaneous coronary intervention in octogenarians with left main or multivessel disease

Mechanisms of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) differ as CABG provides surgical collateralization and may prolong life by preventing future myocardial infarctions (MI). However, CABG benefits are unclear in octogenarians, where surgical risk is often perceived as higher and PCI is chosen more liberally. We performed a meta-analysis of studies comparing outcomes in octogenarians with left main or multivessel disease who underwent CABG or PCI. Primary outcome was late mortality (> 5 years). Secondary outcomes were perioperative mortality, MI, re-revascularization (R-R), acute renal failure (ARF), and stroke. Fourteen studies with 17,942 patients were included. CABG was associated with lower late mortality (hazard ratio, HR: 1.23, 95% confidence interval: CI 1.05–1.44, p < 0.01). In the pooled Kaplan–Meier analysis CABG showed significantly lower risk of death in the follow-up compared to PCI (HR: 1.08, 95%CI 1.02–1.41, p = 0.005). Landmark analyses confirmed the survival advantage of CABG over PCI after 21.5 months of follow-up (HR: 1.31, 1.19–1.44, p < 0.0001), but suggested advantage of PCI over CABG in the first 30-days (HR: 0.72, 0.64–0.82, p < 0.0001) and comparable survival from 1 to 21.5 months (HR: 0.98, 0.92–1.05, p = 0.652). We found lower risk for MI and R-R after CABG but higher perioperative mortality and no differences in ARF and stroke. CABG appears superior to PCI over time in octogenarians with complex CAD. This survival advantage is associated with fewer events of MI and R-R; however, it comes with an increased risk in perioperative mortality.

Abstract 12160: Sex Differences in Outcomes of Percutaneous Coronary Intervention in Octogenarians: A Retrospective Cohort Study From National Inpatient Sample 2016-2019

Introduction: The role of sex-based differences in the outcomes after principal percutaneous coronary intervention (PCI) in octogenarians is not well studied. Hypothesis: There are no differences in outcomes of PCI in octogenarians based on sex. Methods and Results: From 2016 to 2019, 37,147 hospitalizations (unweighted sample) for principal PCI procedures were identified. Among the principal PCI procedures performed, 44.9% (n = 16,660) were performed in females, and 55.2% (n = 20,487) in males (p &lt; 0.001), 82.4% in Whites, 5.4% in Blacks, 6.4% in Hispanics, and 2.6% in Asians. 20,986 (56.5%) principal PCI hospitalizations had a Charlson comorbidity index (CCI) of three or higher. The mean age for Octogenarians was 83.6 ± 2.7 years. Compared to males, the females were slightly older (mean age: 83.8 vs. 83.5; p &lt; 0.001), had higher prevalence of diabetes mellitus (20.5% vs 18%, p&lt;0.001) and lower Charlson comorbidity index (CCI) of three or higher (53.6% vs. 58.9%, p &lt;0.001). Females had higher incidence of cardiogenic shock (4.9% vs 4.2%, p=0.002), higher in-hospital mortality (4% vs 3%, p&lt;0.001) and longer length of stay (LOS) (4.4 days vs 4.1 days, p&lt;0.001). Multivariate regression analysis showed that, compared to males, females had a significantly higher odds of in-hospital mortality (aOR: 1.23; 95% CI: 1.10, 1.37; p &lt;0.001) and cardiogenic shock (aOR: 1.17; 95% CI: 1.06, 1.30; p=0.002) after controlling for age, race, hospital region, hospital teaching status, income, insurance provider, and CCI. From 2016-2019, in octogenarians, the annual incidence of principal PCI hospitalizations increased from 127 per 100,000 hospitalizations in 2016 to 137 per 100,000 hospitalizations in 2019, p&lt;0.001. Conclusions: The incidence of PCI done in octogenarians is rising every year. Females have an increased likelihood of in-hospital mortality, longer LOS, and cardiogenic shock.

Percutaneous coronary intervention in octogenarians: 10-year experience from a primary percutaneous coronary intervention centre with off-site cardiothoracic support.

OBJECTIVETo examine the trends in patient characteristics and clinical outcomes over a ten-year period and to analyse the predictors of mortality in octogenarians undergoing percutaneous coronary intervention (PCI) in our centre.METHODSA total of 782 consecutive octogenarians (aged 80 and above) were identified from a prospectively collected PCI database within our non-surgical, medium volume centre between 1st January 2007 and 31st December 2016. This represented 10.9% of all PCI procedures performed in our centre during this period. We evaluated the demographic and procedural characteristics of the cohort with respect to clinical outcomes (all-cause in-hospital and 1-year mortality, in-hospital complication rates, duration of hospital admission, coronary disease angiographic complexity and major co-morbidities). The cohort was further stratified into three chronological tertiles (January 2007 to July 2012, 261 cases; August 2012 to May 2015, 261 cases; June 2015 to December 2016, 260 cases) to assess for differences over time. Predictors of mortality were identified through a multivariate regression analysis.RESULTSThe number of octogenarians undergoing PCI increased nearly ten-fold over the studied period. Despite this, there were no significant differences in clinical outcomes or patient characteristics, except for the increased use of trans-radial vascular access [11.9% in first tertile vs. 73.2% in third tertile (P < 0.0001)]. The all-cause in-hospital (5.8% vs. 4.6% vs. 3.8%, P = 0.578) and 1-year mortality (12.4% vs. 12.5% vs. 14.4%, P = 0.746) remained constant in all three tertiles respectively. Six independent predictors of mortality were identified - increasing age [HR = 1.12 (1.03−1.22), P = 0.008], cardiogenic shock [HR = 16.40 (4.04–66.65), P < 0.0001], severe left ventricular impairment [HR = 3.52 (1.69−7.33), P = 0.001], peripheral vascular disease [HR = 2.73 (1.22−6.13), P = 0.015], diabetes [HR = 2.59 (1.30−5.17), P = 0.007] and low creatinine clearance [HR = 0.98 (0.96−1.00), P = 0.031]. CONCLUSIONThis contemporary observational study provides a useful insight into the real-world practice of PCI in octogenarians.

Five-year outcomes after coronary artery bypass grafting and percutaneous coronary intervention in octogenarians with complex coronary artery disease.

We assessed the clinical effectiveness of coronary artery bypass grafting (CABG) in comparison with that of percutaneous coronary intervention (PCI) in octogenarians with triple-vessel disease (TVD) or left main coronary artery (LMCA) disease. From the CREDO-Kyoto registry cohort-2, 527 patients, who were ≥ 80years of age and underwent the first coronary revascularization for TVD or LMCA disease, were divided into the CABG group (N = 151) and the PCI group (N = 376). The median and interquartile range of patient's age was 82 (81-84) in the CABG group and 83 (81-85) in the PCI group (P = 0.10). Patients > = 85years of age accounted for 19% and 31% in the CABG and PCI groups, respectively (P = 0.01). The cumulative 5-year incidence of all-cause death was similar between CABG and PCI groups (35.8% vs. 42.9%, log-rank P = 0.18), while CABG showed a lower rate of the composite of cardiac death/MI than PCI (21.7% vs. 33.9%, log-rank P = 0.005). After adjusting for confounders, the lower risk of CABG relative to PCI was significant for all-cause death (HR 0.61, 95% CI 0.43-0.86, P = 0.005), any coronary revascularization (HR 0.25, 95% CI 0.14-0.43, P < 0.001) and the composite of cardiac death/MI (HR 0.52, 95% CI 0.32-0.85, P = 0.009). CABG compared with PCI was associated with a lower adjusted risk for all-cause death, any coronary revascularization, and a composite of cardiac death/MI in very elderly patients with TVD or LMCA disease. CABG seemed an acceptable option for selected octogenarians with severe coronary artery disease.

Chronic total occlusion percutaneous coronary intervention in octogenarians and nonagenarians.

The outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in octogenarians and nonagenarians have received limited study. We compared in-hospital outcomes of CTO PCI between patients ≥80 vs. <80-years-old in 6233 CTO PCIs performed between 2012 and 2020 at 33 U.S. and international centers. There were 415 octogenarians and nonagenarians in our study (7% of the total population). Compared with younger patients, octo- and nonagenarians were less likely to be men (73% vs. 83.2%, p< 0.0001) and more likely to have atrial fibrillation (27% vs. 12%, p< 0.0001) and prior coronary artery bypass graft surgery (CABG) (43% vs. 29%, p< 0.0001). They were more likely to have CTOs with moderate/severe calcification (71% vs. 46%, p< 0.0001), but had similar mean J-CTO scores (2.5± 1.3 vs. 2.4± 1.3, p= 0.08). They had lower technical and procedural success (82.2% vs. 86.3%, p= 0.0201; 80.3% vs. 84.8%, p= 0.016, respectively) and higher incidence of in-hospital major adverse cardiovascular events (3.4% vs. 1.8%, p= 0.021). On multivariable analysis PCI in octo- and nonagenarians was not independently associated with technical and procedural success or with in-hospital MACE. CTO PCI is feasible in octo- and nonagenarians, although success rates are lower, and the risk of complications is higher compared with younger patients, likely related to more comorbidities and higher coronary lesion complexity.

Percutaneous coronary intervention in octogenarians: A risk scoring system to predict 30-day outcomes in the elderly.

Octogenarians are a high-risk group presenting for percutaneous coronary intervention (PCI). We aimed to create a 30-day mortality risk model for octogenarians presenting with both acute coronary syndrome (ACS) and chronic stable angina (CSA), using comprehensive mandatory UK data submissions to the UK National database. Octogenarians are a high-risk group presenting for percutaneous coronary intervention, and decisions on whether or not to undertake intervention in this cohort can be challenging. The increasing number of octogenarians in the general population means they represent an important high-risk subgroup of patients. The data group consisted of 425,897 PCI procedures undertaken in the UK between 2008 and 2012 during which time there was comprehensive data linkage to mortality via the Office of National Statistics. Of these procedures, 44,221 (10.4%) were in patients aged ≥80. These comprised the model group. Logistic regression was used to create a predictive score which ultimately consisted of the following weightings: age 80-89 (n =1); age > 90 (n =2); unstable angina/non-ST-elevation myocardial infraction (NSTEMI) (n =1); STEMI (n =2); creatinine >200 mmol/L (n =1); preprocedural ventilation (n =1); left ventricular ejection fraction <30% (n =1); cardiogenic shock (n =2). Multiple imputation was used to account for missing data. The patient cohort was divided into a derivation (n =22,072) and a validation dataset (n =22,071). Receiver operating characteristic analyses were used to derive the area-under-the-curve to assess properties of the score. The scoring system generated an AUC 0.83, (95% CI 0.80-0.85) suggesting high sensitivity and specificity. Scores of 1-4 were associated with good survival but scores ≥5 were associated with an estimated likelihood of death within 30 days of ≥40%. This octogenarian risk score maybe a useful tool to determine the chance of a successful outcome in elderly patients presenting for PCI.

Percutaneous coronary intervention in octogenarians – a real-world experience from a large non-surgical centre in the UK

Abstract Background With an ageing population, the demand for percutaneous coronary intervention (PCI) in the elderly is on the rise. Technical advances, better peri-procedural pharmacology and greater operator experience have led to improved outcomes after PCI. Octogenarians as a group, however, have been underrepresented in randomised clinical trials of coronary revascularisation. Observational studies therefore provide useful insights into the safety and efficacy of PCI in this patient population in a real-world clinical practice. Aim The aim of this study was to examine the trends in patient characteristics and clinical outcomes after PCI in octogenarians over a 10-year period in a large non-surgical PCI centre and to determine the predictors of mortality in this high risk patient cohort. Methods A total of 782 consecutive octogenarians were identified from a prospectively collected database of all patients undergoing PCI at our centre between 2007 and 2016. We analysed the characteristics of the cohort with respect to all-cause in-hospital and 1-year mortality, in-hospital Major Adverse Cardiovascular Events (MACE) rates, complexity of coronary artery disease and major comorbidities. The patients were stratified into three chronological tertiles to assess differences over time. A multivariate analysis was performed to determine predictors of mortality. Results The number of octogenarians undergoing PCI was found to have increased nearly ten-fold, from 19 in 2007 to 178 in 2016. Despite this, there were no significant differences in adverse clinical outcomes. A greater use of radial access was noted (p&amp;lt;0.0001). Increasing age, the presence of cardiogenic shock, severe left ventricular impairment, peripheral vascular disease, diabetes mellitus and low creatinine clearance were identified as independent predictors of mortality after PCI (Table 1). Conclusion PCI in octogenarians is a safe and effective revascularisation option, the use of which is increasing in the real-world clinical practice. Future PCI randomised clinical trials should include this challenging cohort to enhance the evidence base. Funding Acknowledgement Type of funding source: None

Prognostic impact of percutaneous coronary intervention in octogenarians with non-ST elevation myocardial infarction: A report from SWEDEHEART.

Percutaneous coronary intervention (PCI) improves outcomes in non-ST elevation acute coronary syndromes (NSTE-ACSs). Octogenarians, however, were underrepresented in the pivotal trials. This study aimed to assess the effect of PCI in patients ≥80 years old. We used data from the SWEDEHEART registry for all hospital admissions at eight cardiac care centres within Västra Götaland County. Consecutive patients ≥80 years old admitted for NSTE-ACS between January 2000 and December 2011 were included. We performed instrumental variable analysis with propensity score. The primary endpoint was all-cause mortality at 30 days and one year after index hospitalization. During the study period 5200 patients fulfilled the inclusion criteria. In total, 586 (11.2%) patients underwent PCI, the remaining 4613 patients were treated conservatively. Total mortality at 30 days was 19.4% (1007 events) and 39.4% (1876 events) at one year. Thirty-day mortality was 20.7% in conservatively treated patients and 8.5% in the PCI group (adjusted odds ratio 0.34; 95% confidence interval 0.12-0.97, p = 0.044). One-year mortality was 42.1% in the conservatively treated group and 16.3% in the PCI group (adjusted odds ratio 0.97; 95% confidence interval 0.36-2.51, p = 0.847). PCI in octogenarians with NSTE-ACS was associated with a lower risk of mortality at 30 days. However, this survival benefit was not sustained during the entire study-period of one-year.

Intervenção coronária percutânea em octogenários no Brasil. Dados da última década

Background As the population ages, the prevalence of diseases has increased, particularly that of coronary artery disease requiring treatment. The objective of this study was to assess the temporal evolution of percutaneous coronary intervention in octogenarians in Brazil. Methods Based on data from the Central Nacional de Intervenções Cardiovasculares (CENIC), we analyzed procedures carried out in patients aged 80 years and over, from June 2006 to March 2016, classified into three time ranges: 2006-2008, 2009-2011 and 2012-2016. We assessed [...]

TCT-694 Outcome of High Risk Percutaneous Coronary Intervention in Octogenarians: Insight from the from the cVAD Registry

TCT-694 Outcome of High Risk Percutaneous Coronary Intervention in Octogenarians: Insight from the from the cVAD Registry

Clinical Outcomes of Percutaneous Coronary Intervention in Octogenarians

Background: Octogenarians are high risk patients and largely under-represented in clinical trials. The use of evidence-based therapy is, therefore, lower in this age group, resulting in a reliance on non-evidence based decision making. The elderly usually have higher prevalence of co morbidities and more often experience complications during and after revascularization procedures.Methods: 212 patients with ischemic heart disease who underwent percutaneous coronary intervention (PCI) were divided into 2 groups according to age: ³80 years (n = 74) and &lt; 80 years (n = 138). Baseline clinical characteristics, indications for coronary intervention, in hospital outcomes and 1 year outcome were obtained. Study endpoint was in hospital outcome (Renal impairment, MI, LVF, emergency revascularization, death) &amp; 1 year follow up for myocardial infarction (MI), repeat revascularization and death.Results: Procedural success (TIMI III) were high in both groups, but still lower in the elderly as compared to younger group (95% vs. 97%, p=0.65).The elderly had higher incidence of post PCI bleeding, contrast induced nephropathy (CIN), MI, left ventricular failure (LVF) and death (9.5% vs.6.1%, 8.2% vs.3.7%, 6.8% vs.5.8%, 9.5% vs. 5.1% and 5.4%vs.3.6%, p=0.07). Whereas emergency revascularization were higher in younger group (5.4% vs. 6.5%, p=0.07). At 1 year MI and death were higher in elderly group (9.5% vs.6.5%, 6.8% vs.6.5% p=0.66), whereas repeat revascularization were higher in younger group (6.8% vs.8%, p= 0.66).Conclusion: Though immediate interventional procedure related complications are more in octogenarians, long term outcomes seem to be promising &amp; comparable with younger counterparts.Cardiovasc. j. 2018; 10(2): 121-125

Bleeding outcomes after non-emergency percutaneous coronary intervention in the very elderly.

BackgroundOctogenarians constitute an increasing proportion of patients presenting for non-emergency percutaneous coronary intervention (PCI).MethodsThis study evaluated the in-hospital procedural characteristics and outcomes, including the bleeding events of 293 octogenarians presenting between January 2010 and December 2012 for non-emergency PCI to a single large volume tertiary care Australian center. Comparisons were made with 293 consecutive patients aged less than or equal to 60 years, whose lesions were matched with the octogenarians.ResultsNon-ST elevation myocardial infarction was the most frequent indication for non-emergency PCI in octogenarians. Compared to the younger cohort, they had a higher prevalence of co-morbidities and more complex coronary disease, comprising more type C and calcified lesions. Peri-procedural use of low molecular weight heparin (LMWH; 1.0% vs. 5.8%; P < 0.001) and glycoprotein IIb/IIIa inhibitors (2.1% vs. 9.6%; P < 0.001) was lower, while femoral arterial access was used more commonly than in younger patients (80.9% vs. 67.6%; P < 0.001). Overall, there was a non-significant trend towards higher incidence of all bleeding events in the elderly (9.2% vs. 5.8%; P = 0.12). There was no significant difference in access site or non-access site bleeding and major or minor bleeding between the two cohorts. Sub-analysis did not reveal any significant influence on bleeding rates by the use of LMWH, glycoprotein IIb/IIIa inhibitors or femoral arterial access. In addition, there were no significant differences in the rates of in-hospital mortality, stroke or acute stent thrombosis between the two groups.ConclusionsIn this single center study, we did not observe significant increases in adverse in-hospital outcomes including the incidence of bleeding in octogenarians undergoing non-emergency PCI.

TCT-333 Percutaneous Coronary Intervention in Octogenarians: A Risk Scoring System to Predict Outcomes in the Elderly On behalf of the British Cardiovascular Intervention Society (BCIS), and the National Institute for Cardiovascular Outcomes Research (NICOR)

TCT-333 Percutaneous Coronary Intervention in Octogenarians: A Risk Scoring System to Predict Outcomes in the Elderly On behalf of the British Cardiovascular Intervention Society (BCIS), and the National Institute for Cardiovascular Outcomes Research (NICOR)

Primary percutaneous coronary intervention in octogenarians

BackgroundLimited data are available on the outcome of primary percutaneous coronary intervention (PCI) in octogenarian patients, as the elderly are under-represented in randomized trials. This study aims to provide insights on clinical characteristics, management and outcome of the elderly and very elderly presenting with STEMI. Methods2225 STEMI patients ≥70years old (mean age 76.8±5.1years and 53.8% men) were admitted into the network of the ISACS-TC registry. Of these patients, 72.8% were ≥70 to 79years old (elderly) and 27.2% were ≥80years old (very-elderly). The primary end-point was 30-day mortality. ResultsThirty-day mortality rates were 13.4% in the elderly and 23.9% in the very-elderly. Primary PCI decreased the unadjusted risk of death both in the elderly (OR: 0.32, 95% CI: 0.24–0.43) and very-elderly patients (OR: 0.45, 95% CI 0.30–0.68), without significant difference between groups. In the very-elderly hypertension and Killip class ≥2 were the only independent factors associated with mortality; whereas in the elderly female gender, prior stroke, chronic kidney disease and Killip class ≥2 were all factors independently associated with mortality. Factors associated with the lack of use of reperfusion were female gender and atypical chest pain in the very-elderly and in the elderly; in the elderly, however, there were some more factors, namely: history of diabetes, current smoking, prior stroke, Killip class ≥2 and history chronic kidney disease. ConclusionsAge is relevant in the prognosis of STEMI, but its importance should not be considered secondary to other major clinical factors. Primary PCI appears to have beneficial effects in the octogenarian STEMI patients.

Short and intermediate term outcome of percutaneous coronary intervention in octogenarians

Short and intermediate term outcome of percutaneous coronary intervention in octogenarians

A case study of percutaneous coronary intervention for the treatment of unprotected left main coronary artery in octogenarians

Objective To retrospectively analyze the safety and short-term efficacy of percutaneous coronary intervention in octogenarians (aged ≥80 years) with unprotected left main coronary artery disease (ULMCA). Methods Clinical data of octogenarians with ULMCA undergoing stent implantation were selected. Clinical and radiographic outcomes before and after treatment, and major adverse cardiac events (MACE) during admission and one year follow-up period were collected. Results A total of 36 octogenarians with ULMCA undergoing percutaneous coronary intervention (PCI) were enrolled in this study. Lesions involved ostium (6 cases), shaft (10 cases), both ostium and bifurcation (3 cases), bifurcation (14 cases) and diffuse (3 cases). All patients successfully received stent implantation, with incomplete reconstruction of blood supply in 35 cases and complete reconstruction of blood supply in 1 case. During a one year follow-up period, recurrent angina pectoris was noted in one patient 2 months after PCI, and angina pectoris remained after re-stent within one year. No angina pectoris and MACE occurred in the other 35 patients. Conclusions Stent implantation may be relatively safely for the treatment of ULMCA in octogenarians who refuse or are unsuitable for coronary artery bypass grafting. Key words: Coronary Vessels; Stent; Angioplasty, transluminal, percutaneous coronary

Predictors of long-term outcome of percutaneous coronary intervention in octogenarians with acute coronary syndrome

The majority of patients with acute coronary syndrome (ACS) are elderly. Limited evidence makes decision-making on the use of percutaneous coronary intervention (PCI) mainly empirical. Old age is one risk factor, but other factors than age may have an impact on mortality as well. Therefore, we investigated predictors of long-term all-cause mortality among octogenarians who have undergone PCI due to ACS. A total of 182 patients ≥ 80 years who underwent PCI during 2006–2007 at Sahlgrenska University Hospital were studied consecutively from recorded clinical data. All-cause five-year mortality of follow-up was 46.2%. Mean age was 83.7 ± 2.8, 62% were male, 76% were in sinus rhythm, and 42% had left ventricular ejection fraction < 45%. Indications for PCI were STEMI (52%), NSTEMI (36%) and unstable angina (11%). Multivariate analysis in two steps identified atrial fibrillation, moderate tricuspid valve regurgitation, moderate mitral valve regurgitation, dependency in ADL and eGFR ≤ 30 ml/min at the first step and moderate mitral valve regurgitation, atrial fibrillation and eGFR ≤ 30 ml/min at the last step, as independent predictors of all-cause mortality. Kaplan Meier analysis of positive parameters from both steps of multivariate analysis showed high significant difference in survival between patients having these parameters and those who were free from these parameters, with worst prognosis in patients with accumulation of these parameters. Accordingly, we have, in an octogenarian patient cohort who suffered from ACS, undergone PCI in daily clinical practice, identified five prognostic predictors for all-cause death after five years' follow-up.

Unprotected Left Main Percutaneous Coronary Intervention in a 108-Year-Old Patient

With the increase in life expectancy, the proportion of very elderly people is increasing. Coronary artery disease (CAD) is an important cause of mortality and morbidity in this age group, for which myocardial revascularization is often indicated. Percutaneous coronary intervention (PCI) in the very elderly bears the inherent risks of complications and mortality, but the potential benefits may outweigh these risks. A number of observational studies, registries, and few randomized controlled trials have shown the safety and feasibility of PCI in octogenarians and nonagenarians. However, PCI is only rarely done in centenarians; so, the outcome of percutaneous coronary revascularization in this age group is largely unknown. PCI in a centenarian with complex CAD is described here; the patient presented with unstable angina despite optimum medical therapy, and surgery was declined. Good angiographic success was followed by non-cardiac complications, which were managed with a multidisciplinary approach.

TCT-46 Effects of Radial versus Femoral Accesses for Percutaneous Coronary Interventions in Octogenarians with Acute Coronary Syndromes

TCT-46 Effects of Radial versus Femoral Accesses for Percutaneous Coronary Interventions in Octogenarians with Acute Coronary Syndromes

Quantification and prognosis of incomplete coronary revascularization after percutaneous coronary intervention in octogenarians

Quantification and prognosis of incomplete coronary revascularization after percutaneous coronary intervention in octogenarians