Survival After Coronary Revascularization in the Elderly

Abstract

Background-Elderly patients with ischemic heart disease are increasingly referred for coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). However, reports of poor outcomes in the elderly have led to questions about the benefit of these strategies. We studied survival by prescribed treatment (CABG, PCI, or medical therapy) for patients in 3 age categories: Ͻ70 years, 70 to 79 years, and Ն80 years of age. Methods and Results-The Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease (APPROACH) is a clinical data collection and outcome monitoring initiative capturing all patients undergoing cardiac catheterization and revascularization in the province of Alberta, Canada, since 1995. Characteristics and long-term outcomes of a cohort of Ͼ6000 elderly patients with ischemic heart disease were compared with younger patients. In 15 392 patients Ͼ70 years of age, 4-year adjusted actuarial survival rates for CABG, PCI, and medical therapy were 95.0%, 93.8%, and 90.5%, respectively. In 5198 patients 70 to 79 years of age, survival rates were 87.3%, 83.9%, and 79.1%, respectively. In 983 patients Ն80 years of age, survival was 77.4% for CABG, 71.6% for PCI, and 60.3% for medical therapy. Absolute risk differences in comparison to medical therapy for CABG (17.0%) and PCI (11.3%) were greater for patients Ն80 years of age than for younger patients. Conclusions-Elderly patients paradoxically have greater absolute risk reductions associated with surgical or percutaneous revascularization than do younger patients. The combination of these results with a recent randomized trial suggests that the benefits of aggressive revascularization therapies may extend to subsets of patients in older age groups. (Circulation.

Predictors of the early outcome in elderly patients with ST elevation myocardial infarction treated with primary angioplasty: a single center experience

“…Claessen et al [7] recently report an increasing percentage of octogenarians treated with primary percutaneous coronary intervention (PCI) from 1997 to 2007, who show an increased short-and long-term mortality when compared to younger patients. This finding is in keeping with earlier clinical trials such as GISSI-2 and GUSTO-1 [8,9] as well as with previous studies in the era of mechanical revascularization by others [10][11][12][13][14][15] and us [16].…”

“…Higher comorbidities and a higher incidence of PCI failure may account for this finding. Most studies have reported that older age is associated with decreased procedural success after PCI or increased in-hospital complications [10][11][12][13][14], but data on this topic are still controversial. In a retrospective analysis, de Boer et al [27] document that PCI in octogenarians has a high technical and procedural success rate even if older age is independently associated with greater mortality after PCI for AMI.…”

Acute cardiac disease in elder patients

“…Careful monitoring of INR as an outpatient must be emphasized to a departing ED patient as supra-therapeutic INRs are associated with an increased risk of intracranial bleeding. Aspirin can be considered in low-risk patients who are not candidates for anticoagulation; however, it is not an equivalent substitute for warfarin [23]. The BAFTA study of patients greater than 75 years of age finds that warfarin provides a 52% reduction in risk of embolism compared to aspirin [18].…”

The Impact of Age on Effects of Pre-hospital Initiation of High Bolus Dose of Tirofiban Before Primary Angioplasty for ST-Elevation Myocardial Infarction

“…Although primary percutaneous coronary intervention (PCI) is beneficial, elderly patients with ST-elevation myocardial infarction (STEMI) still have a worse prognosis, including worse myocardial reperfusion, as compared to younger patients [1][2][3][4]. Glycoprotein (GP) IIb/IIIa inhibitors are favourable in STEMI patients [5,6], and the additional value of early pre-hospital high bolus dose tirofiban has recently been established [7,8], but combined antithrombin and GP IIb/IIIa inhibitor regimens have also been associated with a higher risk of bleeding [9,10].…”