Related Experiment Video
Updated: Aug 22, 2026
Predicting Amputation using Local Circulating Mononuclear Progenitor Cells in Angioplasty-treated Patients with Critical Limb Ischemia
Published on: September 22, 2020
Multicenter experience in revascularization of very elderly patients
Eric D Peterson1, Karen P Alexander, David J Malenka
1The Outcomes Research and Assessment Group, The Duke Clinical Research Institute, Durham, NC 27715, USA. peter016@mc.duke.edu
Insights
Coronary revascularization procedures like PCI and CABG increased in very elderly patients over a decade. Outcomes improved, but individualized risk assessment remains crucial for this growing population.
Area of Science:
- Cardiology
- Geriatric Medicine
- Health Services Research
Background:
- Elderly patients (> or =75 years) are increasingly referred for revascularization.
- This demographic has been underrepresented in prior clinical trials for PCI and CABG.
- Large US registries were pooled to analyze revascularization in this population.
Purpose of the Study:
- To understand revascularization procedure use in patients aged 75 years and older.
- To evaluate the risks and outcomes associated with PCI and CABG in this age group.
- To identify risk factors for mortality in elderly patients undergoing revascularization.
Main Methods:
- Pooled data from six PCI (n=48,439) and eight CABG (n=180,709) registries from 1990-1999.
- Analyzed patient characteristics, procedural processes, and in-hospital mortality/morbidity.
- Used standardized multivariable logistic regression to identify mortality risk factors.
Main Results:
- Revascularization use in patients aged 75+ increased by 10% between 1991-1999.
- In-hospital mortality was 3.0% for PCI and 5.9% for CABG.
- Mortality rates declined significantly for both procedures in older patients over the decade.
Conclusions:
- Coronary revascularization use and outcomes improved in elderly patients over the last decade.
- While age is a risk factor, significant variability exists among elderly patients.
- Individualized risk assessments are essential for optimizing procedural decisions in this population.
Background:
Very elderly patients are increasingly referred for revascularization yet have been underrepresented in both prior percutaneous coronary intervention (PCI) and coronary bypass surgery (CABG) clinical trials. We pooled the largest PCI and CABG clinical registries in the United States to better understand revascularization procedure use, risks and outcomes in patients aged > or =75 years.
Methods:
Six PCI registries (n = 48,439) and 8 CABG registries (n = 180,709) voluntarily contributed all procedural data in patients aged > or =75 years from 1990 through 1999. Patient characteristics, procedural process, and inhospital mortality and morbidity outcomes were evaluated. Risk factors for mortality in elderly patients were identified and compared across registries using standardized multivariable logistic regression.
Results:
Between the years 1991 and 1999, the proportion of patients aged > or =75 years undergoing revascularization was on the rise (10% increase). Pooled estimates of inhospital mortality following PCI during this decade was 3.0% (range 1.5%-5.2% among databases), and following CABG was 5.9% (range 4.9%-8.4% among databases). Mortality rates declined significantly in older patients for both PCI and CABG over this decade. While process measures varied across registries, the most significant predictors of inhospital death (procedural urgency, left ventricular dysfunction, prior CABG) seemed consistent across all sites.
Conclusion:
Over the last decade, the use of coronary revascularization in elderly patients increased and outcomes improved. While age remains a determinant of procedural risk, this risk varies markedly among elderly patients, emphasizing the need for individualized risk assessments.
