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Decreased usage and increased effectiveness of percutaneous coronary intervention in complex older patients with

Mauro Di Bari1, Daniela Balzi2, Stefania Fracchia1

  • 1Department of Experimental and Clinical Medicine, Research Unit of Medicine of Aging, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.

Heart (British Cardiac Society)
|May 28, 2014
PubMed

Insights

Percutaneous coronary intervention (PCI) is underused in older acute coronary syndrome (ACS) patients due to background risk. However, PCI significantly improves survival in these individuals, especially those with higher risk scores.

Area of Science:

  • Cardiology
  • Geriatric Medicine
  • Health Services Research

Background:

  • Percutaneous coronary intervention (PCI) use is suboptimal in elderly patients with acute coronary syndromes (ACS).
  • Background risk factors may contribute to the underuse and reduced effectiveness of PCI in this population.
  • This study investigated the relationship between background risk and PCI utilization and outcomes in older ACS patients.

Purpose of the Study:

  • To determine if background risk influences PCI application in older ACS patients.
  • To assess the effectiveness of PCI in relation to background risk in this demographic.
  • To identify potential disparities in care for elderly ACS patients.

Main Methods:

  • An observational cohort study utilized data from the Acute Myocardial Infarction in Florence 2 registry.
  • Patients aged 75+ with ACS were selected, and their background risk was assessed using the validated Silver Code (SC) tool.
  • Multivariable logistic regression and Cox proportional hazards models analyzed PCI application rates and 1-year mortality.

Main Results:

  • PCI application decreased by 11% for each point increase in the SC score.
  • 1-year mortality hazard increased by 10% with each SC point increase.
  • PCI demonstrated a progressively greater reduction in 1-year mortality with increasing SC, indicating enhanced effectiveness in higher-risk patients.

Conclusions:

  • PCI use in older ACS patients declines as background risk increases.
  • This trend is not explained by reduced PCI effectiveness in higher-risk individuals.
  • PCI application is associated with a survival benefit that increases with higher background risk scores (SC).
Abstract

Keywords:
Coronary Artery DiseaseQuality of Care and Outcomes

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