Percutaneous coronary intervention in octogenarians – a real-world experience from a large non-surgical centre in the UK

Abstract

Background With an ageing population, the demand for percutaneous coronary intervention (PCI) in the elderly is on the rise. Technical advances, better peri-procedural pharmacology and greater operator experience have led to improved outcomes after PCI. Octogenarians as a group, however, have been underrepresented in randomised clinical trials of coronary revascularisation. Observational studies therefore provide useful insights into the safety and efficacy of PCI in this patient population in a real-world clinical practice. Aim The aim of this study was to examine the trends in patient characteristics and clinical outcomes after PCI in octogenarians over a 10-year period in a large non-surgical PCI centre and to determine the predictors of mortality in this high risk patient cohort. Methods A total of 782 consecutive octogenarians were identified from a prospectively collected database of all patients undergoing PCI at our centre between 2007 and 2016. We analysed the characteristics of the cohort with respect to all-cause in-hospital and 1-year mortality, in-hospital Major Adverse Cardiovascular Events (MACE) rates, complexity of coronary artery disease and major comorbidities. The patients were stratified into three chronological tertiles to assess differences over time. A multivariate analysis was performed to determine predictors of mortality. Results The number of octogenarians undergoing PCI was found to have increased nearly ten-fold, from 19 in 2007 to 178 in 2016. Despite this, there were no significant differences in adverse clinical outcomes. A greater use of radial access was noted (p<0.0001). Increasing age, the presence of cardiogenic shock, severe left ventricular impairment, peripheral vascular disease, diabetes mellitus and low creatinine clearance were identified as independent predictors of mortality after PCI (Table 1). Conclusion PCI in octogenarians is a safe and effective revascularisation option, the use of which is increasing in the real-world clinical practice. Future PCI randomised clinical trials should include this challenging cohort to enhance the evidence base. Funding Acknowledgement Type of funding source: None

Prevalence and prognostic impact of complex percutaneous coronary intervention among octogenarians

“…2,3 Thus, the number of octogenarians referred to PCI is increasing. 2,4 During the study period, around 9% of patients undergoing PCI were octogenarians. Among them more than 50% underwent CPCI, defined by the presence of at least 1 out of 9 CPCI criteria.…”

“…Octogenarians are frequently affected by coronary artery disease (CAD), with more than one‐third having manifest angina symptoms and up to 90% with subclinical coronary atherosclerosis; in addition, CAD represents the leading cause of death in this patient group 2,3 . Referral of octogenarians for percutaneous coronary intervention (PCI) to improve symptoms, quality of life and to reduce myocardial infarction (MI) or unplanned revascularization is becoming progressively more frequent 2,4 . Since octogenarians are more likely than younger patients to have advanced CAD with severely calcified lesions or involving left main or multiple vessels, 2,5–8 they more frequently undergo complex PCI (CPCI).…”

“…quality of life and to reduce myocardial infarction (MI) or unplanned revascularization is becoming progressively more frequent. 2,4 Since octogenarians are more likely than younger patients to have advanced CAD with severely calcified lesions or involving left main or multiple vessels, 2,5-8 they more frequently undergo complex PCI (CPCI). Nonetheless, little is known about the prevalence and prognosis of CPCI among octogenarians.…”

Temporal trends and predictors of time to coronary angiography following non-ST-elevation acute coronary syndrome in the USA

“…There is a vast amount of evidence from single-centre experiences 248 , RCTs 237,238 , and observational studies 236 that consistently demonstrated no differences in PCI clinical outcomes between NSCs and SCs in general. Building upon this existing knowledge, our current study expands the understanding of CHiP procedures in NSCs.…”

“…Results from observational studies 235,236 and randomised control trials (RCT) 237,238 around the safety of PCI in NSCs supported the continuation of the those PCI programs.…”