CLINICAL STUDY
Contemporary outcome trends in the elderly undergoing percutaneous coronary interventions: Results in 7,472 octogenarians
Wayne B. Batchelor, MD, MHSa,1,
Kevin J. Anstrom, MS*,
Lawrence H. Muhlbaier, PhD*,
Ralph Grosswald, MPH ,
William S. Weintraub, MD, FACC ,
William W. O’Neill, MD, FACC ,
Eric D. Peterson, MD, MPH, FACC* for the National Cardiovascular Network Collaboration
a Terrence Donnelly Heart Center, Department of Medicine, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
* Duke University Clinical Research Institute, Durham, North Carolina, USA
National Cardiovascular Network Collaboration, William Beaumont Hospital, Royal Oak, Michigan, USA
Division of Cardiology, William Beaumont Hospital, Royal Oak, Michigan, USA
Emory University, Atlanta, Georgia, USA
Manuscript received September 14, 1999;
revised manuscript received March 1, 2000,
accepted April 13, 2000.
Reprint requests and correspondence: Dr. Wayne B. Batchelor, Terrence Donnelly Heart Center, St. Michael’s Hospital, 30 Bond Street, Toronto, Ontario, Canada
OBJECTIVES
We sought to define the risks facing octogenarians undergoing contemporary percutaneous coronary interventions (PCIs).
BACKGROUND
The procedural risks of PCI for octogenarians have not been well established.
METHODS
We compared the clinical characteristics and in-hospital outcomes of 7,472 octogenarians (mean age 83 years) with those of 102,236 younger patients (mean age 62 years) who underwent PCI at 22 National Cardiovascular Network (NCN) hospitals from 1994 through 1997.
RESULTS
Octogenarians had more comorbidities, more extensive coronary disease and a two- to fourfold increased risk of complications, including death (3.8% vs. 1.1%), Q wave myocardial infarction (1.9% vs. 1.3%), stroke (0.58% vs. 0.23%), renal failure (3.2% vs. 1.0%) and vascular complications (6.7% vs. 3.3%) (p < 0.001 for all comparisons). Independent predictors of procedural mortality in octogenarians included shock (odds ratio [OR] 5.4, 95% confidence interval [CI] 3.3 to 8.8), acute myocardial infarction (OR 3.2, 95% CI 2.3 to 4.4), left ventricular ejection fraction (LVEF) <35% (OR 2.9, 95% CI 2.1 to 3.9), renal insufficiency (OR 2.8, 95% CI 2.0 to 3.8), first PCI (OR 2.3, 95% CI 1.7 to 3.3), age >85 years (OR 2.1, 95% CI 1.5 to 2.7) and diabetes mellitus (OR 1.5, 95% CI 1.1 to 2.0). For elective procedures, octogenarian mortality varied nearly 10-fold, and was strongly influenced by comorbidities (0.79% mortality with no risk factors vs. 7.2% with renal insufficiency or LVEF <35%). Despite similar case-mix, PCI outcomes in octogenarians improved significantly over the four years of observation (OR of 0.61 for death/myocardial infarction/stroke in 1997 vs. 1994; 95% CI 0.45 to 0.85).
CONCLUSIONS
Risks to octogenarians undergoing PCI are two- to fourfold higher than those of younger patients, strongly influenced by comorbidities, and have decreased in the stent era.
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Abbreviations and Acronyms
| | CABG | = coronary artery bypass graft surgery | | CI | = confidence interval | | CVA | = cerebrovascular accident | | DCA | = directional coronary atherectomy | | LAD | = left anterior descending coronary artery | | LVEF | = left ventricular ejection fraction | | MI | = myocardial infarction | | NCN | = National Cardiovascular Network | | OR | = odds ratio | | PCI | = percutaneous coronary intervention |
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