Prevalence and prognostic impact of complex percutaneous coronary intervention among octogenarians
Alessandro Spirito1, Michael Gao1, Samantha Sartori1
1The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Insights
Complex percutaneous coronary interventions (PCI) in octogenarians significantly increase the risk of major adverse cardiovascular events (MACE) and bleeding within one year. These findings highlight the need for strategies to mitigate complications in this elderly population.
Area of Science:
- Cardiology
- Interventional Cardiology
- Geriatric Medicine
Background:
- The number of octogenarians undergoing percutaneous coronary interventions (PCI) is increasing.
- The impact of complex PCI (CPCI) in this elderly group is not well understood.
Purpose of the Study:
- To evaluate the prevalence and prognostic impact of complex PCI in octogenarians.
- To assess the association between CPCI and major adverse cardiovascular events (MACE) and bleeding.
Main Methods:
- Retrospective analysis of 2657 octogenarians undergoing PCI between 2012-2019.
- Patients categorized by PCI complexity (atherectomy, stent length, number of stents, vessel involvement, etc.).
- Primary outcome: 1-year MACE (all-cause death, MI, TVR); Secondary outcome: major bleeding.
Main Results:
- 52% of octogenarians underwent CPCI, often with more comorbidities.
- CPCI was linked to higher 1-year MACE (16.6% vs 11.1%) driven by MI and TVR.
- CPCI also significantly increased major bleeding risk (10% vs 5.8%).
Conclusions:
- Complex PCI in octogenarians is associated with increased risks of MACE and bleeding.
- Higher rates of myocardial infarction and target-vessel revascularization contribute to MACE.
- Implementation of complication-reduction strategies is crucial for octogenarians undergoing CPCI.
Background:
The number of octogenarians referred to percutaneous coronary interventions (PCI) is rising steadily. The prevalence and prognostic impact of complex PCI (CPCI) in this vulnerable population has not been fully evaluated.
Methods:
Patients ≥80 years old who underwent PCI between 2012 and 2019 at Mount Sinai Hospital were included. Patients were categorized based on PCI complexity, defined as the presence of at least one of the following criteria: use of atherectomy, total stent length ≥60 mm, ≥3 stents implanted, bifurcation treated with at least 2 stents, PCI involving ≥3 vessels, ≥3 lesions, left main, saphenous vein graft or chronic total occlusion. The primary outcome was major adverse cardiovascular events (MACE), a composite of all-cause death, myocardial infarction (MI), or target-vessel revascularization (TVR), within 1 year after PCI. Secondary outcomes included major bleeding.
Results:
Among 2657 octogenarians, 1387 (52%) underwent CPCI and were more likely to be men and to have cardiovascular risk factors or comorbidities. CPCI as compared with no-CPCI was associated with a higher 1-year risk of MACE (16.6% vs. 11.1%, adjusted HR 1.3, 95% CI 1.06-1.77, p value 0.017), due to an excess of MI and TVR, and major bleeding (10% vs. 5.8%, adjusted HR 1.64, 95% CI 1.20-2.55, p value 0.002).
Conclusions:
Among octogenarians, CPCI was associated with a significantly higher 1-year risk of MACE, due to higher rates of MI and TVR but not of all-cause death, and of major bleeding. Strategies to reduce complications should be implemented in octogenarians undergoing CPCI.
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