[Do elderly patients benefit from recent advances in the treatment of ischemic heart disease?]
1Department of Cardiology, Tokyo Metropolitan Geriatric Hospital, Japan.
Insights
Emergency percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) in elderly patients shows improved survival rates compared to conservative treatment. Optimal medication and stent choice are crucial for long-term prognosis in this population.
Area of Science:
- Cardiology
- Geriatric Medicine
- Interventional Cardiology
Context:
- Elderly patients with ischemic heart disease often present unique challenges for percutaneous coronary intervention (PCI).
- Acute coronary syndrome (ACS) management in the very elderly requires careful consideration of risks and benefits.
- Transradial approach for PCI is feasible in elderly individuals.
Purpose:
- To evaluate the outcomes of emergency PCI in elderly patients with ACS.
- To identify factors associated with in-hospital and long-term adverse events after PCI in older adults.
- To compare the prognosis of elderly patients undergoing emergency PCI versus those not receiving it.
Summary:
- Emergency PCI for ACS in elderly patients (66-98 years) demonstrated significantly lower mortality (4.6%-7.3%) compared to non-PCI management (20%).
- In-hospital events were linked to anemia, CRP, max CK-MB, and vessel involvement. Long-term prognosis correlated with max CK-MB and renal function.
- Indications for emergency PCI in the elderly should mirror those in younger patients, despite challenges like ambiguous symptoms, dementia, and renal dysfunction. Drug-eluting stents showed better mid-term outcomes than bare-metal stents, although bare-metal stents may be preferable in ACS cases.
Impact:
- Emergency PCI is a viable and beneficial treatment for elderly patients with ACS, improving survival rates.
- Understanding prognostic factors allows for tailored management strategies to optimize outcomes in older adults post-PCI.
- Further research into optimal stent selection and management of comorbidities is warranted for this growing patient population.
Abstract:
Percutaneous coronary intervention (PCI) with a transradial approach can be performed in very elderly patients with ischemic heart disease. In our hospital, 20% of elderly patients, who did not undergo emergency PCI for acute coronary syndrome (ACS), died. In contrast, only 7.3% of the elderly patients with ACS (80-98 yrs old, mean age 85 ± 4 years) died, and 4.6% of those (66-79 yrs old, mean age 73 ± 4 years) died after successful emergency PCI. In-hospital major adverse cardiovascular events were associated with anemia, CRP levels at admission, max CK-MB, and the number of involved vessels. The long-term prognosis of the elderly patients after emergency PCI was good with optimum medication, and it was associated with max CK-MB and renal function. Therefore, the indications for emergency PCI for elderly patients with ACS should be identical to that for young patients. However, elderly patients with ACS often show ambiguous symptoms, which make it difficult for them to undergo emergency PCI. Dementia and renal dysfunction are also problematic. On the other hand, improvement in the long-term prognosis of chronic ischemic heart disease by PCI has been shown in elderly patients, but not in younger patients. Observational monitoring showed a better mid-term prognosis after PCI with drug-eluting stent, but bare metal stents are preferable in cases of elderly patients with ACS.
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