Clinical Outcomes in Older Patients Undergoing Percutaneous Coronary Intervention for Non-ST-Elevation Acute Coronary
Michael Lim1, Diem T Dinh2, Angela Brennan2
1Department of Cardiology, The Alfred Hospital, Melbourne, Vic, Australia.
Insights
Older patients with non-ST-elevation acute coronary syndromes (NSTEACS) undergoing percutaneous coronary intervention (PCI) face risks. Left ventricular dysfunction and renal impairment independently predict major adverse cardiac or cerebrovascular events (MACCE) post-PCI.
Area of Science:
- Cardiology
- Geriatric Medicine
- Interventional Cardiology
Background:
- Identifying optimal treatment for older, comorbid patients with non-ST-elevation acute coronary syndromes (NSTEACS) undergoing percutaneous coronary intervention (PCI) is challenging.
- Risk stratification for major adverse cardiac or cerebrovascular events (MACCE) post-PCI is crucial for this demographic.
- Contemporary outcomes and pre-procedural risk factors for MACCE in elderly NSTEACS patients undergoing PCI require elucidation.
Purpose of the Study:
- To describe the outcomes of older patients (≥80 years) with NSTEACS undergoing PCI.
- To identify pre-procedural risk factors associated with MACCE in this patient group.
Main Methods:
- Retrospective review of 1,875 patients aged ≥80 years with NSTEACS undergoing PCI from the Victorian Cardiac Outcomes Registry (2013-2017).
- MACCE defined as a composite of 30-day mortality, myocardial infarction, stroke, major bleeding, revascularization, in-hospital cardiogenic shock, stent thrombosis, or new dialysis requirement.
- Comparison of demographic data and comorbidities between patients with and without MACCE.
Main Results:
- The overall rate of MACCE at 30 days was 8.0% (n=150), with 30-day mortality at 3.0% (n=57).
- Independent predictors of MACCE included pre-procedural left ventricular ejection fraction <45% (OR 2.32) and estimated glomerular filtration rate (eGFR) ≤30 mL/min/1.73m² or renal replacement therapy (OR 2.10).
Conclusions:
- Older NSTEACS patients with left ventricular systolic dysfunction or renal impairment are at significantly higher risk of MACCE after PCI.
- Further randomized trials are needed to compare the efficacy of invasive management versus medical therapy for these high-risk patients.
Background:
Distinguishing the subgroup of older, comorbid patients presenting with non-ST-elevation acute coronary syndromes (NSTEACS) who will benefit from percutaneous coronary intervention (PCI) remains challenging. Identifying risk factors for major adverse cardiac or cerebrovascular events (MACCE) post PCI may help define this cohort. The objective of this study was to describe contemporary outcomes of older patients with NSTEACS undergoing PCI and identify pre-procedural risk factors for MACCE.
Methods:
We retrospectively reviewed data for 1,875 patients aged ≥80 years entered in the Victorian Cardiac Outcomes Registry (VCOR) who underwent PCI for NSTEACS between 1 January 2013 and 31 December 2017. MACCE was a composite outcome comprising 30-day mortality, myocardial infarction, stroke, major bleeding, target lesion revascularisation or target vessel revascularisation; in-hospital cardiogenic shock or stent thrombosis; and new requirement for dialysis. Patient demographic data and pre-procedural comorbidities were compared between the groups with and without a MACCE.
Results:
The rate of MACCE at 30 days was 8.0% (n=150). Thirty-day (30-day) mortality was 3.0% (n=57). Pre-procedural left ventricular ejection fraction (LVEF)<45% (OR 2.32; 95% CI 1.47-3.68; p<0.001) and eGFR≤30 mL/min/1.73m2 or renal replacement therapy (OR 2.10; 95% CI 1.27-3.46; p<0.01) were independent predictors of a MACCE.
Conclusions:
Older patients presenting with NSTEACS who have left ventricular systolic dysfunction or renal impairment are at increased risk of MACCE post PCI. Randomised studies are required to determine if invasive management remains beneficial for these patents compared with medical therapy.
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