Optimal medical therapy after percutaneous coronary intervention in very elderly patients with coronary artery
Takamitsu Nakamura1, Takeo Horikoshi1, Tsuyoshi Kobayahi1
1Department of Cardiovascular Medicine, University of Yamanashi, Faculty of Medicine, Chuo, Japan.
Insights
Optimal medical therapy (OMT) after percutaneous coronary intervention (PCI) significantly reduces major adverse clinical events in patients aged 80 and older with coronary artery disease (CAD). This therapy appears safe and effective for this elderly population.
Area of Science:
- Cardiology
- Geriatric Medicine
- Interventional Cardiology
Background:
- Long-term clinical outcomes of optimal medical therapy (OMT) post-percutaneous coronary intervention (PCI) in octogenarian patients with coronary artery disease (CAD) remain unclear.
- Investigating the impact of OMT on major adverse clinical events (MACE) in this specific elderly demographic is crucial.
Purpose of the Study:
- To evaluate the efficacy and safety of OMT in patients aged 80 years and older undergoing PCI for CAD.
- To determine if OMT reduces long-term adverse clinical events in this very elderly population.
Main Methods:
- A multicenter registry analysis of 1056 patients aged >80 years treated with PCI.
- OMT defined as antiplatelet, statin, beta-blocker, and ACE inhibitor/ARB combination.
- Primary endpoint: time to first major adverse clinical event (death or nonfatal myocardial infarction) up to 3 years post-PCI.
Main Results:
- 204 patients received OMT, 852 received sub-optimal medical therapy (sub-OMT).
- OMT group showed a significantly lower probability of adverse clinical events (p<0.01).
- Propensity score matching and multivariate analysis confirmed OMT significantly reduced the risk of adverse events (HR 0.44; p=0.003).
Conclusions:
- OMT after PCI is associated with significantly fewer adverse clinical events, including death and nonfatal myocardial infarction, in patients aged ≥80 years with CAD.
- OMT demonstrates potential safety and effectiveness for very elderly patients with CAD undergoing PCI.
Background:
It is still unclear whether optimal medical therapy (OMT) after percutaneous coronary intervention (PCI) has beneficial effects on long-term clinical outcomes in patients aged ≥80 years with coronary artery disease (CAD).
Methods:
This study analyzed the time to the first major adverse clinical event including death or nonfatal myocardial infarction (MI), for up to 3 years after PCI using multicenter registry data. Data for 1056 patients aged > 80 years successfully treated with PCI were included in the analysis. OMT was defined as a combination of antiplatelet drug, statin, beta-blocker, and angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker.
Results:
In total, 204 (19%) patients in this study received OMT and 852 (81%) received sub-OMT. During a median follow-up of 725 days, adverse clinical events occurred in 183 patients (death, n=177; nonfatal MI, n=6). Kaplan-Meier analysis showed that patients who received OMT had a lower probability of adverse clinical events than those who received sub-OMT (p<0.01, log-rank test). Propensity score matching yielded 202 patient-pairs treated with OMT or sub-OMT, in whom 64 adverse clinical events (death, n=56, nonfatal MI, n=4) occurred during follow-up. OMT remained significant in the reduction of the risk of adverse clinical events in a multivariate Cox proportional hazards model (hazard ratio 0.44; 95% confidence interval 0.26-0.75; p=0.003).
Conclusions:
OMT after PCI was associated with significantly fewer adverse clinical events, including all-cause death and nonfatal MI, in patients aged ≥ 80 years with CAD. OMT might be safe and effective for these very elderly patients.
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