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CLINICAL STUDY

Percutaneous coronary interventions in octogenarians

glycoprotein IIb/IIIa receptor inhibitors’ safety profile

^* Division of Cardiology, William Beaumont Hospital, Royal Oak, Michigan, USA

Manuscript received November 18, 2002; revised manuscript received January 29, 2003, accepted February 20, 2003.

^* Reprint requests and correspondence: Dr. Cindy L. Grines, Director, Cardiac Catheterization Laboratories, William Beaumont Hospital, 3601 West 13 Mile Road, Royal Oak, Michigan 48073, USA.
cgrines{at}beaumont.edu

Presented in part at the 51st Annual Scientific Session of the American College of Cardiology, Atlanta, Georgia, March 2002.

OBJECTIVES: This study was designed to evaluate the safety profile of glycoprotein IIb/IIIa receptor inhibitors (GPI) in octogenarians undergoing percutaneous coronary intervention (PCI).

BACKGROUND: Patients 80 years old constitute the fastest growing segment of the U.S. population and have a high prevalence of coronary artery disease. Few data exist regarding the use of GPI during PCI in octogenarians, as these patients have been excluded from randomized clinical trials of GPI.

METHODS: Consecutive patients 80 years old undergoing PCI between January 1998 and June 2001 were evaluated for clinical outcomes and bleeding complications.

RESULTS: One thousand three hundred and ninety two of 14,308 patients (9.7%) undergoing PCI were 80 years old. Of these, 459 of 1,392 (33%) of the patients were treated with GPI. Octogenarians treated with GPI were more likely to present with acute coronary syndrome or infarction, receive stents, require an intra-aortic balloon pump, or undergo multi-vessel PCI. Glycoprotein receptor inhibitor use was associated with a higher rate of bleeding, but the transfusion rate was similar to that in patients who did not receive GPI (9.8% vs. 8.6%, p = NS). No cases of intracranial hemorrhage were observed. By multivariate analysis, GPI treatment was associated with longer hospitalization but did not independently predict the need for transfusion or affect mortality.

CONCLUSIONS: Octogenarians have a high incidence of bleeding and need for transfusion after PCI. Although the use of GPI was associated with more access and non-access site bleeding and longer hospital stay, GPI treatment does not significantly increase the risk of transfusion or intracranial hemorrhage in this non-randomized cohort.

Abbreviations and Acronyms   ACS   acute coronary syndrome   CK-MB   creatine kinase-MB fraction   GPI   glycoprotein IIb/IIIa receptor inhibitor   IABP   intra-aortic balloon pump   LOS   length of stay after PCI   MI   myocardial infarction   PCI   percutaneous coronary intervention

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