[Are very old patients good candidates for percutaneous coronary intervention? A monocentric retrospective study]
A-L Deman1, P Schiano, M-C Chenilleau
1HIA Val-de-Grâce, 74, boulevard Port-Royal 75005 Paris, France. anne.deman1@gmail.com
Insights
Percutaneous coronary intervention (PCI) is feasible in very old patients, demonstrating similar technical success rates. However, older individuals experienced higher in-hospital mortality due to more complex disease.
Area of Science:
- Cardiology
- Interventional Cardiology
- Geriatric Cardiology
Background:
- The elderly population is growing, with a high prevalence of ischemic heart disease.
- Coronary interventions offer potential benefits for this demographic.
Purpose of the Study:
- To assess the feasibility of percutaneous coronary intervention (PCI) in patients over 85 years old.
- To compare outcomes between very elderly patients and a younger cohort undergoing PCI.
Main Methods:
- Retrospective analysis of a percutaneous coronary intervention (PCI) database from January 2008 to March 2009.
- Comparison of population characteristics, clinical presentation, lesion type, procedural details, and in-hospital outcomes between patients >85 years and others.
Main Results:
- Among 3130 PCI patients, 85 were >85 years old. Older patients had higher rates of acute coronary syndrome and silent ischemia, worse ejection fraction, and more complex lesions, particularly in the left descending artery.
- Technical success rates were comparable (93.28% vs. 94.32%), as were periprocedural complication rates (2.35% vs. 1.5%).
- In-hospital mortality was significantly higher in the >85 group (7% vs. 1.38%).
Conclusions:
- Percutaneous coronary intervention (PCI) is a safe procedure for very elderly patients.
- Higher in-hospital mortality in this group is attributed to more severe disease and comorbidities.
- Further research is needed to establish specific recommendations for very elderly patients undergoing PCI.
Aim:
To determine the feasibility of percutaneous coronary intervention (PCI) in very old patients.
Background:
The elderly are a growing population with a high prevalence of ischemic heart disease and then subsequent possibility to benefit from coronary interventions.
Method:
We have conducted a retrospective study using our PCI database since January 2000. Population characteristics, clinical presentation, type of lesions, technical procedure, immediate results and in hospital outcome are compare between patients older than 85 and the other.
Results:
Between January 2008 and March 2009, 3130 patients benefit from coronary angioplasty. Among them, 85 patients were older than 85. There were more female in this group (24.7 vs. 14.3%, P=0.007), but no difference in cardiovascular risk profile. The older was more symptomatic (acute coronary syndrome: 59.52 vs. 44%, P=0.004; silent ischemia: 3.6 vs. 25.7%, P=0.000003). The ejection fraction was worse (EF<55%: 29.4 vs. 14.5%, P=0.0001). The lesion was more complex (B2 and C: 67.2 vs. 57.1% P=0.027) and concern more often the left descending artery (85.9 vs. 57.1%, P=0.000001). The technical success was similar in the two groups (93.28 vs. 94.32%, P=0.34) with similar rate of per procedure complications (2.35 vs. 1.5%, P=0.37). Nevertheless, the in-hospital rate mortality was higher in the older patients (7 vs 1.38%, P=0.0014).
Conclusion:
PCI is safe and safety in very old patients despite significant but acceptable increasing in-hospital mortality due to more severe disease and co morbidities. Further evaluations are necessary in order to edict specific recommendations.
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