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Percutaneous coronary intervention for unprotected left main distal bifurcation lesions in elderly people

Yusuke Watanabe1,2, Toru Naganuma2, Alaide Chieffo1

  • 1San Raffaele Scientific Institute, Milan, Italy.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|July 11, 2024
PubMed

Insights

Elderly patients undergoing percutaneous coronary intervention for unprotected left main distal bifurcation lesions face higher mortality. Low geriatric nutritional risk index (GNRI) in these patients is strongly linked to poorer clinical outcomes.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Geriatric Medicine

Background:

  • Percutaneous coronary intervention (PCI) is a primary treatment for unprotected left main distal bifurcation lesions (ULMD) in elderly patients due to high surgical risks.
  • Geriatric nutritional risk index (GNRI) is a known predictor of outcomes in elderly patients undergoing interventional procedures.

Purpose of the Study:

  • To assess clinical outcomes following PCI for ULMD in elderly patients.
  • To evaluate the impact of GNRI on these outcomes.

Main Methods:

  • A registry study identified 669 patients receiving drug-eluting stents for ULMD.
  • Patients were categorized into elderly (≥75 years) and younger (<75 years) groups.
  • The elderly group was further divided based on median GNRI to assess nutritional status impact. Primary endpoint was all-cause mortality.

Main Results:

  • Elderly patients exhibited significantly higher all-cause mortality (adjusted HR 2.37).
  • Elderly patients with low GNRI showed substantially increased mortality compared to other groups (adjusted HR 3.56).
  • Cardiovascular mortality was similar, but target lesion revascularization (TLR) rates were lower in the elderly group.

Conclusions:

  • Elderly individuals undergoing PCI for ULMD have a worse prognosis regarding all-cause mortality.
  • Low GNRI is a critical factor associated with significantly poorer outcomes in this elderly population.
Abstract

Keywords:
drug eluting stentelderlygeriatric nutritional risk indexpercutaneous coronary interventionunprotected left main distal bifurcation lesions

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