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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
American Heart Journal
|September 25, 2004
Summary
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.