Outcomes After Percutaneous Coronary Intervention for Chronic Coronary Disease in Adults ≥ 75 versus < 75 Years

While PCI is widely used for chronic coronary disease (CCD), older adults (≥ 75 years) face distinct procedural risks, and their outcomes compared with younger patients remain incompletely understood.

We investigated age-related differences in health outcomes following PCI for CCD using Vizient Clinical Data Base that includes both inpatient and outpatient PCI. Vizient aggregates clinical and outcome data from over 97% of U.S. academic medical centers and 1000+ community hospitals. We included all patients that underwent PCI for CCD between January 2016 and June 2022. The primary outcome was the occurrence of major adverse cardiovascular events (MACE). After propensity-score matching older (≥ 75 years) and younger (< 75 years) adults, we analyzed major adverse cardiovascular events (MACE) in the year following index PCI using Kaplan-Meier curves. Relative risks (RR) were calculated using Zou's modified Poisson approach. Secondary outcomes included all-cause mortality, repeat PCI, major bleeding, and cardiovascular-related hospitalizations.

A total of 176,492 patients were included. 70.5% of patients were < 75 years old, while 29.5% were ≥ 75 years old. Most PCIs for CCD occurred in the outpatient setting (51.0%), followed by inpatient (28.6%), observation (17.1%), and other (3.3%) settings. Older adults experienced lower adjusted risk of MACE (relative risk [RR] 0.93, 95% confidence interval [CI] 0.89-0.96), as well as MI or repeat PCI, compared with younger adults. They experienced higher risk of hospitalization for a cardiovascular cause (RR 1.40, 95% CI 1.36-1.44). No significant difference was observed in the risk of all-cause mortality or major bleeding.

After adjusting for baseline differences, older adults who undergo PCI for CCD have a risk of MACE and major bleeding that is comparable to younger patients. However, older adults do experience higher rates of subsequent cardiovascular hospitalizations following PCI for CCD.