Related Experiment Video
Updated: May 1, 2026
Coronary Progenitor Cells and Soluble Biomarkers in Cardiovascular Prognosis after Coronary Angioplasty
Published on: January 28, 2020
Does specific interventional risk scoring better predict mortality than comorbidity in nonagenerians undergoing
Julian O M Ormerod1, Steve Ramcharitar1
1Wiltshire Cardiac Centre, Great Western Hospital, Swindon SN3 6BB, UK.
Insights
The New York PTCA score is a better predictor of survival in patients over 90 undergoing percutaneous coronary intervention (PCI) than other risk scores. This suggests that advanced age alone should not preclude nonagenarians from PCI if they are hemodynamically stable.
Area of Science:
- Cardiology
- Geriatric Medicine
- Interventional Cardiology
Background:
- Assessing the risk profile and outcomes of patients aged 90 years and older undergoing percutaneous coronary intervention (PCI).
- Evaluating multiple risk scores including Charlson Comorbidity Index, SYNTAX, Logistic SYNTAX, New York PTCA, and frailty indices in 24 consecutive patients.
- Determining the most effective predictor of survival in this elderly cohort.
Discussion:
- The New York PTCA score demonstrated superior predictive power for in-hospital and 12-month mortality compared to Charlson Comorbidity Index, SYNTAX, and logistic SYNTAX scores.
- Patients with a New York PTCA score above 9% had a significantly higher mortality rate, while those below this threshold had no in-hospital deaths.
- Despite advanced age, nonagenarians undergoing PCI in this study exhibited relatively low comorbidity and SYNTAX scores.
Key Insights:
- The New York PTCA score is a more potent predictor of survival in nonagenarian PCI patients than other common risk stratification tools.
- Clinical factors captured by the New York PTCA score, such as hemodynamic instability and renal failure, are critical in risk assessment.
- Frailty and comorbidity indices did not significantly differentiate between survivors and non-survivors at discharge or 12 months.
Outlook:
- Further validation of the New York PTCA score in larger cohorts of very elderly patients undergoing PCI is warranted.
- These findings may encourage reconsideration of PCI in carefully selected nonagenarian patients, challenging age as an absolute contraindication.
- The study highlights the importance of comprehensive clinical assessment beyond chronological age for interventional decisions in the oldest patients.
Background:
Preliminary study to assess the risk profile and outcomes of patients aged over 90years at the time of percutaneous coronary intervention.
Methods:
A database search was performed to identify patients 90years or over at the time of percutaneous coronary intervention. Risk profile scores (Charlson Comorbidity Index, SYNTAX, Logistic clinical SYNTAX, New York PTCA score and frailty indices) were evaluated on 24 consecutive patients in order to determine the best predictor for survival. Between both groups (survivors and non-survivors) unpaired Student's t-test was used to determine statistical significance.
Results:
The New York PTCA score was significantly higher in those patients that died in hospital (n=5) when compared to those who survived to discharge (n=19) (NY PTCA score of 20.9±5.4 vs. 4.5±0.8, p<0.001) and this was also seen with mortality at 12months. The level of co-morbidity (Charlson index) was similar in patients who died in hospital (n=5) compared with those who survived to discharge (n=19, Charlson comorbidity index of 3.4±0.7 vs.3.9±0.6, p=0.70). This trend was also observed at 1year. The average level of frailty (by the CSHA Clinical Frailty Scale), SYNTAX score and logistic clinical SYNTAX were not significantly different between the two groups both at discharge and at 12months. Choosing an arbitrary New York PTCA score of 9%, nearly two thirds of patients above this level died, whereas no patient below this level of risk died in hospital.
Conclusion:
This small observational study found that nonagenarians who underwent PCI had relatively low comorbidity and SYNTAX scores. The specific coronary intervention (New York PTCA) risk score appears to have more predictive power in this small group of patients than the other three scores. Crucially, the factors that determine risk by New York PTCA score - haemodynamic instability, shock, pulmonary oedema, renal failure, etc. - are commonly encompassed by an "end-of-bed" assessment of the patient and these patients that pass this test ought not to be denied PCI on the basis of their advanced years.
More Related Videos
Related Concept Videos
01:27Coronary Artery Disease V: Interprofessional Care
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:26Coronary Artery Disease IV: Preventive Measures