Acute coronary syndrome in octogenarians: association between percutaneous coronary intervention and long-term
Salim Bary Barywani1, Shijun Li2, Maria Lindh1
1Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Sahlgrenska University Hospital/Östra Hospital, Gothenburg, Sweden.
Insights
Percutaneous coronary intervention (PCI) significantly improves long-term survival for elderly patients with acute coronary syndrome (ACS). This study found PCI reduced mortality by over 50% in octogenarians with ACS over five years.
Area of Science:
- Cardiology
- Geriatric Medicine
- Interventional Cardiology
Background:
- Elderly patients (≥80 years) with acute coronary syndrome (ACS) have limited evidence regarding survival benefits from percutaneous coronary intervention (PCI).
- Assessing the long-term impact of PCI on mortality in this vulnerable population is crucial for clinical decision-making.
Purpose of the Study:
- To evaluate the association between percutaneous coronary intervention (PCI) and long-term mortality in octogenarians diagnosed with acute coronary syndrome (ACS).
Main Methods:
- A cohort of 353 patients aged ≥80 years hospitalized with ACS was analyzed.
- Patients were divided into two groups: 182 treated with PCI and 171 not treated with PCI.
- Propensity score matching and Cox regression analysis were used to adjust for baseline characteristics and assess mortality association.
Main Results:
- PCI-treated patients demonstrated significantly lower 5-year all-cause mortality (46.2%) compared to non-PCI-treated patients (89.5%) in the overall cohort.
- In the propensity-matched cohort, PCI was associated with improved mean survival rates (48 months vs. 35 months) and reduced long-term mortality (HR 0.5, P=0.029).
- Adjusted Cox regression confirmed PCI's association with reduced mortality, even after accounting for multiple confounders.
Conclusions:
- Percutaneous coronary intervention (PCI) is associated with improved survival in octogenarians experiencing acute coronary syndrome (ACS).
- The findings suggest PCI offers a significant survival benefit for very elderly patients with ACS over a 5-year follow-up period.
Aim:
Evidence of improved survival after use of percutaneous coronary intervention (PCI) in elderly patients with acute coronary syndrome (ACS) is limited. We assessed the association between PCI and long-term mortality in octogenarians with ACS.
Methods And Results:
We followed 353 consecutive patients aged ≥80 years hospitalized with ACS during 2006-2007. Among them, 182 were treated with PCI, whereas 171 were not. PCI-treated patients were younger and more often male, and had less stroke and dependency in activities of daily living, but there were no significant differences in occurrence of diabetes mellitus, chronic obstructive pulmonary disease, hypertension, and uncured malignancies between the two groups. The association between PCI and all-cause mortality was assessed in the overall cohort and a 1:1 matched cohort based on propensity score (PS). In overall cohort, 5-year all-cause mortality was 46.2% and 89.5% in the PCI and non-PCI groups, respectively. Cox regression analysis in overall cohort by adjustment for ten baseline variables showed statistically significant association between PCI and reduced long-term mortality (P<0.001, hazard ratio 0.4, 95% confidence interval [CI] 0.2-0.5). In propensity-matched cohort, 5-year all-cause mortality was 54.9% and 83.1% in the PCI and non-PCI groups, respectively. Kaplan-Meier survival curves and log rank test showed significantly improved mean survival rates (P=0.001): 48 months (95% CI 41-54) for PCI-treated patients versus 35 months (95% CI 29-42) for non-PCI-treated patients. Furthermore, by performing Cox regression analysis, PCI was still associated with reduced long-term mortality (P=0.029, hazard ratio 0.5, 95% CI 0.3-0.9) after adjustment for PS and confounders: age, male sex, cognitive deterioration, uncured malignancies, left ventricular ejection fraction ≤45%, estimated glomerular filtration rate ≤35 mL/min, ST-segment elevation myocardial infarction, mitral regurgitation, and medication at discharge with clopidogrel and statins.
Conclusion:
In octogenarians with ACS, PCI was associated with improved survival from all-cause death over 5 years of follow-up.
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