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Percutaneous coronary interventions in octogenarians. glycoprotein IIb/IIIa receptor inhibitors' safety profile
H Mehrdad Sadeghi1, Cindy L Grines, Harish R Chandra
1Division of Cardiology, William Beaumont Hospital, Royal Oak, Michigan 48073, USA.
Objectives:
This study was designed to evaluate the safety profile of glycoprotein IIb/IIIa receptor inhibitors (GPI) in octogenarians undergoing percutaneous coronary intervention (PCI).
Background:
Patients > or =80 years old constitute the fastest growing segment of the U.S. population and have a high prevalence of coronary artery disease. Few data exist regarding the use of GPI during PCI in octogenarians, as these patients have been excluded from randomized clinical trials of GPI.
Methods:
Consecutive patients > or =80 years old undergoing PCI between January 1998 and June 2001 were evaluated for clinical outcomes and bleeding complications.
Results:
One thousand three hundred and ninety two of 14,308 patients (9.7%) undergoing PCI were > or =80 years old. Of these, 459 of 1,392 (33%) of the patients were treated with GPI. Octogenarians treated with GPI were more likely to present with acute coronary syndrome or infarction, receive stents, require an intra-aortic balloon pump, or undergo multi-vessel PCI. Glycoprotein receptor inhibitor use was associated with a higher rate of bleeding, but the transfusion rate was similar to that in patients who did not receive GPI (9.8% vs. 8.6%, p = NS). No cases of intracranial hemorrhage were observed. By multivariate analysis, GPI treatment was associated with longer hospitalization but did not independently predict the need for transfusion or affect mortality.
Conclusions:
Octogenarians have a high incidence of bleeding and need for transfusion after PCI. Although the use of GPI was associated with more access and non-access site bleeding and longer hospital stay, GPI treatment does not significantly increase the risk of transfusion or intracranial hemorrhage in this non-randomized cohort.
Insights
Glycoprotein IIb/IIIa receptor inhibitors (GPI) use in octogenarians undergoing percutaneous coronary intervention (PCI) is associated with increased bleeding but not higher transfusion or intracranial hemorrhage risk. This study highlights safety in elderly patients.
Area of Science:
- Cardiology
- Geriatric Medicine
- Interventional Cardiology
Background:
- Octogenarians represent a rapidly growing demographic with high rates of coronary artery disease.
- Limited data exists on glycoprotein IIb/IIIa receptor inhibitor (GPI) use in octogenarians during percutaneous coronary intervention (PCI) due to their exclusion from clinical trials.
Purpose of the Study:
- To evaluate the safety and outcomes of glycoprotein IIb/IIIa receptor inhibitors (GPI) in patients aged 80 years and older undergoing percutaneous coronary intervention (PCI).
Main Methods:
- A retrospective analysis of consecutive patients aged 80 years and older undergoing PCI between January 1998 and June 2001.
- Evaluation of clinical outcomes and bleeding complications, comparing patients treated with GPI versus those not treated.
Main Results:
- Of 14,308 patients undergoing PCI, 9.7% were octogenarians; 33% of these received GPI.
- GPI use was linked to higher rates of bleeding and longer hospitalizations but not increased transfusion rates or intracranial hemorrhage.
- Multivariate analysis indicated GPI treatment was associated with longer hospitalization but did not independently predict transfusion needs or mortality.
Conclusions:
- Octogenarians undergoing PCI experience a high incidence of bleeding and transfusion needs.
- While GPI use in this cohort is associated with increased bleeding and hospital stay, it does not significantly elevate the risk of transfusion or intracranial hemorrhage.
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