Are the elderly different? Factors influencing mortality after percutaneous coronary intervention with stent
J Schröder1, U Müller-Werdan, S Reuter
1Universitätsklinik und Poliklinik für Innere Medizin III, Universitätsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle, Germany. jochen.schroeder@medizin.uni-halle.de
Insights
Elderly patients (≥75 years) undergoing percutaneous coronary intervention (PCI) face higher mortality. Arterial hypertension significantly increased mortality in this group, while antiplatelet therapy reduced it.
Area of Science:
- Cardiology
- Geriatric Medicine
- Interventional Cardiology
Background:
- Percutaneous coronary intervention (PCI) is a common procedure for coronary heart disease (CHD).
- Assessing mortality risk factors in elderly patients (≥75 years) post-PCI is crucial for optimizing care.
- Older adults may experience different outcomes compared to younger populations after PCI.
Purpose of the Study:
- To investigate factors influencing mortality after PCI in patients aged ≥75 years compared to younger patients.
- To identify specific risk and protective factors for mortality in elderly PCI recipients.
- To compare mortality predictors across different age groups undergoing PCI.
Main Methods:
- Retrospective analysis of 1,809 CHD patients who underwent PCI with stent implantation.
- Kaplan-Meier and Cox regression analyses were used to assess all-cause mortality.
- Three Cox regression models were applied, incorporating age, cardiovascular risk factors (CVRFs), and additional clinical parameters.
Main Results:
- Age ≥75 years was a significant predictor of mortality across all models.
- In elderly patients (≥75 years), arterial hypertension was associated with increased mortality (HR 7.989), while antiplatelet therapy showed reduced mortality (HR 0.098).
- For all patients, stroke, PAD, diabetes, elevated creatinine, and increased LDL-C predicted higher mortality; higher hemoglobin and LVEF >50% were protective.
Conclusions:
- While stroke, PAD, diabetes, renal insufficiency, and anemia predict mortality in all PCI patients, arterial hypertension is a key risk factor specifically in the elderly (≥75 years).
- Treatment with platelet inhibitors was found to decrease mortality in elderly PCI patients.
- These findings highlight the importance of tailored risk assessment and management strategies for elderly patients undergoing PCI.
Background:
The aim of this study was to investigate factors influencing mortality after percutaneous coronary intervention (PCI) in patients aged ≥ 75 years compared to younger patients.
Patients And Methods:
A total of 1,809 coronary heart disease (CHD) patients after PCI with stent implantation in our hospital were assessed. Kaplan-Meier analyses with log-rank test and Cox regression analyses were performed on three predefined models concerning primary endpoint of all-cause mortality. Model 1 was a univariate analysis of the influence of age dichotomized by age 75 years on the primary endpoint. Model 2 included age and classical cardiovascular risk factors (CVRFs, e.g., body mass index (BMI), smoking, diabetes, and hypertension). Model 3 consisted of age, classical CVRFs, and additional factors (e.g., medication; hemoglobin, peripheral arterial disease (PAD), low-density lipoprotein cholesterol (LDL-C) and creatinine levels, and left ventricular ejection fraction (LVEF)).
Results:
In the mean follow-up of 137 ± 61 weeks 375 patients died. Age ≥ 75 years was significantly related to mortality in all models. In model 3, previous stroke, PAD, diabetes, elevated levels of serum creatinine, and increased LDL-C were related to elevated mortality, higher hemoglobin levels, and LVEF > 50% were associated with decreased mortality in all patients and in patients < 75 years. In patients ≥ 75 years arterial hypertension was associated with poor outcome (hazard ratio (HR) 7.989, p = 0.040), previous antiplatelet therapy showed reduced mortality (HR 0.098, p = 0.039).
Conclusion:
Although risk factors such as previous stroke, PAD, diabetes, renal insufficiency, and anemia were predictors for death in all patients and patients < 75 years, in the elderly only arterial hypertension increased, whereas treatment with platelet inhibitors decreased mortality.
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