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Outcomes of percutaneous coronary intervention for chronic total occlusions in the elderly: A systematic review and

Chenmin Cui1, Zhichao Sheng2

  • 1Department of Nephrology, Huzhou Hospital of Traditional Chinese Medicine Affiliated Zhejiang University of Traditional Chinese Medicine, Huzhou, China.

Clinical Cardiology
|December 17, 2020
PubMed

Insights

Elderly patients undergoing percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) face higher long-term risks, though successful PCI reduces mortality and major adverse cardiac events (MACE). Success rates for CTO-PCI are lower in this age group.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Geriatric Medicine

Background:

  • Percutaneous coronary intervention (PCI) is a key treatment for chronic total occlusions (CTO).
  • Outcomes in elderly patients (≥75 years) undergoing CTO-PCI require specific evaluation due to potential comorbidities and altered physiological responses.
  • Understanding the safety and efficacy of CTO-PCI in older adults is crucial for optimizing cardiovascular care.

Purpose of the Study:

  • To compare outcomes of CTO-PCI in elderly versus nonelderly patients.
  • To assess the impact of successful CTO-PCI on mortality and major adverse cardiac events (MACE) specifically in the elderly population.

Main Methods:

  • A systematic literature search was conducted across major databases (PubMed, Embase, ScienceDirect, CENTRAL, Google Scholar) up to October 2020.
  • Meta-analysis compared in-hospital and long-term mortality and MACE between elderly and nonelderly patients.
  • The study also analyzed the success rates of CTO-PCI and its impact on outcomes in elderly patients.

Main Results:

  • Elderly patients showed a trend towards higher in-hospital MACE and significantly increased long-term mortality and MACE compared to nonelderly patients.
  • The success rate of CTO-PCI was significantly lower in elderly individuals.
  • Successful CTO-PCI in the elderly was associated with a significant reduction in both long-term mortality and MACE.

Conclusions:

  • Elderly patients undergoing CTO-PCI experience higher long-term mortality and MACE, with lower procedural success rates.
  • Successful CTO-PCI in elderly patients significantly mitigates the risks of long-term mortality and MACE.
  • These findings highlight the importance of careful patient selection and procedural optimization for CTO-PCI in older adults.
Abstract

Keywords:
chronic total occlusionscomplicationscoronary artery diseasemortalitypercutaneous coronary interventionsurvival

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