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Percutaneous coronary intervention in octogenarians: A risk scoring system to predict 30-day outcomes in the elderly
James Cockburn1, Tiffany Kemp1, Peter Ludman2
1Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.
Insights
A new risk score helps predict 30-day mortality for octogenarians undergoing percutaneous coronary intervention (PCI). Scores of 5 or higher indicate a significantly increased risk of death, aiding clinical decisions for elderly patients.
Area of Science:
- Cardiology
- Geriatric Medicine
- Health Informatics
Background:
- Octogenarians represent a high-risk group undergoing percutaneous coronary intervention (PCI).
- Clinical decision-making for PCI in octogenarians is challenging due to their increased risk.
- The growing octogenarian population necessitates better risk stratification tools.
Purpose of the Study:
- To develop a 30-day mortality risk model for octogenarians undergoing PCI.
- To utilize comprehensive UK national data for model creation.
- To assess risk in both acute coronary syndrome (ACS) and chronic stable angina (CSA) patients.
Main Methods:
- Analysis of 425,897 PCI procedures in the UK (2008-2012), with 44,221 in patients aged ≥80.
- Logistic regression used to create a predictive score incorporating age, ACS/STEMI status, creatinine, ventilation, ejection fraction, and cardiogenic shock.
- Multiple imputation handled missing data; model validated on separate datasets.
Main Results:
- The developed octogenarian risk score demonstrated high sensitivity and specificity with an Area Under the Curve (AUC) of 0.83.
- Scores of 1-4 were associated with good survival rates.
- Scores of 5 or greater predicted a ≥40% likelihood of 30-day mortality.
Conclusions:
- The novel octogenarian risk score can be a valuable tool for predicting PCI outcomes in elderly patients.
- This score aids in determining the likelihood of successful intervention in this high-risk cohort.
- Improved risk assessment can support more informed clinical decisions for octogenarians undergoing PCI.
Objective:
Octogenarians are a high-risk group presenting for percutaneous coronary intervention (PCI). We aimed to create a 30-day mortality risk model for octogenarians presenting with both acute coronary syndrome (ACS) and chronic stable angina (CSA), using comprehensive mandatory UK data submissions to the UK National database.
Background:
Octogenarians are a high-risk group presenting for percutaneous coronary intervention, and decisions on whether or not to undertake intervention in this cohort can be challenging. The increasing number of octogenarians in the general population means they represent an important high-risk subgroup of patients.
Methods:
The data group consisted of 425,897 PCI procedures undertaken in the UK between 2008 and 2012 during which time there was comprehensive data linkage to mortality via the Office of National Statistics. Of these procedures, 44,221 (10.4%) were in patients aged ≥80. These comprised the model group. Logistic regression was used to create a predictive score which ultimately consisted of the following weightings: age 80-89 (n = 1); age > 90 (n = 2); unstable angina/non-ST-elevation myocardial infraction (NSTEMI) (n = 1); STEMI (n = 2); creatinine >200 mmol/L (n = 1); preprocedural ventilation (n = 1); left ventricular ejection fraction <30% (n = 1); cardiogenic shock (n = 2). Multiple imputation was used to account for missing data.
Results:
The patient cohort was divided into a derivation (n = 22,072) and a validation dataset (n = 22,071). Receiver operating characteristic analyses were used to derive the area-under-the-curve to assess properties of the score. The scoring system generated an AUC 0.83, (95% CI 0.80-0.85) suggesting high sensitivity and specificity. Scores of 1-4 were associated with good survival but scores ≥5 were associated with an estimated likelihood of death within 30 days of ≥40%.
Conclusions:
This octogenarian risk score maybe a useful tool to determine the chance of a successful outcome in elderly patients presenting for PCI.
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