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CLINICAL STUDY

Percutaneous coronary interventions in octogenarians in the American College of Cardiology–National Cardiovascular Data Registry

Development of a nomogram predictive of in-hospital mortality

Lloyd W. Klein, MD, FACC^*,*, Peter Block, MD, FACC, Ralph G. Brindis, MD, FACC, Charles R. McKay, MD, FACC, Ben D. McCallister, MD, FACC^||, Michael Wolk, MD, FACC^¶, William Weintraub, MD, FACC ACC–NCDR Registry^*¶¶

^* Rush-Presbyterian-St. Luke’s Medical Center, Chicago, Illinois, USA
Emory University, Atlanta, Georgia, USA
Kaiser Permanente, San Francisco, California, USA
University of Iowa, Iowa City, Iowa, USA
^|| Mid-America Heart Institute, Kansas City, Missouri, USA
^¶ Weill Medical College of Cornell University, New York, New York, USA

Manuscript received November 26, 2001; revised manuscript received April 4, 2002, accepted May 14, 2002.

^* Reprint requests and correspondence: Dr. Lloyd W. Klein, Rush-Presbyterian-St. Luke’s Medical Center, 1653 W. Congress Parkway, 1035 Jelke Pavilion, Chicago, Illinois 60612, USA.
lklein{at}rush.edu

OBJECTIVES: We sought to evaluate the results of percutaneous coronary intervention (PCI) in elderly patients in contemporary practice.

BACKGROUND: Prior studies of PCI in the elderly population demonstrate increased in-hospital mortality, but these studies are limited by small population size.

METHODS: Using the American College of Cardiology–National Cardiovascular Data Registry (ACC–NCDR) of 100,253 patients, the in-hospital outcomes in all 8,828 PCI procedures performed on octogenarians were evaluated. Patients underwent PCI between 1998 and 2000 at over 145 participating centers.

RESULTS: The mean age was 83.72 ± 3.02 years, with female preponderance (53%). The PCI was considered angiographically successful in 93%, stents were placed in 75%, and the post-PCI length of stay was 3.3 ± 5.1 days. Overall in-hospital mortality was 3.77% but was only 1.35% in PCI without recent myocardial infarction (MI) within one week (p < 0.0001). Patients having PCI within 6 h of the onset of their MI had an increase in mortality tenfold (13.79%) compared with patients without a recent MI (p < 0.0001). All groups that were defined based on time of PCI after MI onset up to seven days had increased mortality (all p < 0.0001). Older age (odds ratio [OR] of 1.03 per incremental year), depressed ejection fraction (EF) (OR 0.69 per 10 points for EF <60%), and time of PCI after MI onset (<6 h, OR 6.87; 6 to 24 h, OR 5.66; 24 h to one week, OR 2.93) were most strongly predictive of outcome by multivariate analysis. The predicted mortality from the multivariate model correlated well with the observed in-hospital mortality up to 20% mortality. A 254-point nomogram was constructed employing the logistic model using a weighted point system.

CONCLUSIONS: In patients 80 years old, PCI has good success and acceptable mortality. The presence of an acute or recent MI substantially increases the risk of in-hospital death.

Abbreviations and Acronyms   ACC   American College of Cardiology   AHA   American Heart Association   CABG   coronary artery bypass graft surgery   CVA   cerebrovascular accident   EF   ejection fraction   LV   left ventricular   NCDR   National Cardiovascular Data Registry   NHLBI   National Heart, Lung, and Blood Institute   PCI   percutaneous coronary intervention

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