Immediate and Long-Term Results of Coronary Angioplasty in Patients Aged 80 Years and Older

Abstract

Objectives. To observe the short- and long-term outcomes after percutaneous coronary intervention (PCI) in octogenarians (>80 y.o.) at our institution. Method. All octogenarians who underwent PCI during the study period were retrospectively retrieved from our database and clinically followed. Major adverse cardiac (and cerebral) events (MAC(C)E) was considered as primary outcome. Results. From January 2003 to December 2007, 140 octogenarians (mean age: 85±3 y.o., 79% of male) underwent PCI and were clinically followed 14±11 months. Procedural success was obtained in 100 percent of patients with single vessel disease, in 96 percent of patients with double vessel disease, and in 75 percent of patients with triple vessel disease. In-hospital, 30 days, and one year MACE rates were 5%, 5%, and 10.7%, respectively. Impaired left ventricular (LV) ejection fraction (hazard ratio (HR) = 0.909, 95% confidence interval (CI) = 0.856 to 0.964, P = .002), diabetes mellitus (HR = 5.792, 95% CI = 1.785 to 18.796, P = .003), and low GFR (HR = 2.943, 95% CI = 1.161, to 7.464, P = .023) were independently associated with an increase risk of MACE at long-term followup. Conclusion. Coronary angiography can be successfully performed in elderly patients with single and double vessel disease. The results in triple vessel disease are encouraging. Low LV function, diabetes, and impaired renal function increase the risk of long-term major adverse cardiac events.

A simple score for the prediction of stent thrombosis in patients with ST elevation myocardial infarction: TIMI risk index

“…Some experimental studies have found that a procoagulant state exists in older patients because of the activation of the intrinsic coagulation system, decreased fibrinolytic activity, or alterations in platelet function. 16,17 Also, it is well-known that older patients with coronary artery disease tend to have more diffused, tortuous, and calcified lesions, which may undoubtedly affect the optimal apposition of the stent to the artery wall, thereby increase the risk of ST. 18 In common with these study’s findings, a large observational cohort study showed that older patients have elevated risk of ST after pPCI. 19…”

Outcomes after primary percutaneous coronary intervention in octogenarians and nonagenarians with ST‐segment elevation myocardial infarction: From the Western Denmark heart registry

“…The reason is thought to be multifactorial. Previous studies have shown that age alone is a strong predictor for short‐ and long‐term mortality after PPCI . Furthermore coexisting geriatric conditions and previous ischemic heart disease with subsequent left ventricular dysfunction may contribute to the unfavourable prognosis .…”