Outcome of Contemporary Percutaneous Coronary Intervention in the Elderly and the Very Elderly: Insights From the Blue Cross Blue Shield of Michigan Cardiovascular Consortium

Abstract

Background: There is a paucity of data on the outcome of contemporary percutaneous coronary intervention (PCI) in the elderly. Accordingly, we assessed the impact of age on outcome of a large cohort of patients undergoing PCI in a regional collaborative registry. Hypothesis: Increasing age is associated with a higher incidence of procedural-related complications. Results: Of the cohort, 64.64% were <70 years of age, 23.83% were 70 to 79 years, 7.85% were 80 to 84 years, 3.09% were 85 to 89 years, and 0.58% were 90 years or older. Increasing age was associated with an increase in all-cause in-hospital mortality, contrast-induced nephropathy, transfusion, stroke/transient ischemic attack, and vascular complications. The overall in-hospital mortality rate was 1.09% and increased from 0.67% in those younger than 70 years up to 5.44% in those 90 years old or greater. The mortality rate in patients over 80 years approached 12% to 15% for those with ST-segment myocardial infarction and 39% in cardiogenic shock patients. Conclusions: The proportion of elderly patients referred for PCI is increasing. Procedural complications increase with age, and patients presenting with unstable symptoms are at the highest risk.

The clinical, angiographic and prognosis characteristics of elderly patients with acute ST-segment elevation myocardial infarction—The first elderly STEMI population study in northwest of China

“…It is a common view that the elderly STEMI patients, especially the ≥75 year population, have more complex coronary artery disease and high complications risks [4][5][6][7][8]. And our research had similar findings that the ≥75 year STEMI group had more serious clinical characteristics in comparison with the 60-75 year group.…”

Medium- to long-term outcomes in percutaneous coronary intervention in the very elderly population

“…These complication rates were in line with the other published studies. Thomas et al reported increased risk of adverse events in elderly patients undergoing PCI with an approximate 4% in-hospital mortality, 1% stroke and 4% vascular complications [17]. The STEMI group has higher in-hospital mortality rate (10%) in our series, which is in concordance with existing data [17,18].…”

“…In addition, subgroup analysis of the GRACE registry suggests that an octogenarian population following a presentation with highrisk non-ST-elevation acute coronary syndrome has significantly less mortality when PCI is performed [11]. The adverse outcomes such as all-cause in-hospital mortality, contrast-induced nephropathy, transfusion, stroke/transient ischemic attack and vascular complications are higher with increasing age [17]. (7) Total MACE, n (%) a 82 (54) MACE: major adverse cardiac events.…”

Pre-Procedural Risk Score of Contrast-Induced Nephropathy in Elderly Patients Undergoing Elective Coronary Angiography

“…Furthermore, it indicated that CIN in elderly patients may be associated with prolonged renal dysfunction and poor prognosis. According to a recent study 14) in a large cohort of patients undergoing percutaneous coronary intervention (PCI), the overall in-hospital mortality rate was 1.09%, and it increased from 0.67% to 5.44%, compared with those in patients < 70 years and > 90 years. Furthermore, it was also pointed out that increasing age was associated with an increase in in-hospital mortality rates and CIN incidence.…”