The Dilemma of Success: Percutaneous Coronary Interventions in Patients > or = 75 Years of Age-Successful but Associated With Higher Vascular Complications and Cardiac Mortality

Catheter Cardiovasc Interv. 2003 Jun;59(2):195-9. doi: 10.1002/ccd.10532.

Abstract

Elderly patients are increasingly referred to percutaneous coronary interventions (PCIs). Recent reports suggest complications rates are declining in the elderly. We sought to determine whether procedural and in-hospital outcomes are different in patients aged > or = 75 years undergoing nonemergent PCI as compared to patients age < 75 years. The outcome of 266 consecutive patients age > or = 75 years undergoing nonemergent PCI was compared to that of 1,681 consecutive patients age < 75 years. Compared with younger patients, greater proportions of elderly patients were women and had a history of hypertension, peripheral vascular disease, and cerebral vascular events. Elderly patients had more extensive coronary involvement. Procedural success was similar in both groups (94%). The in-hospital cardiac death rate was significantly higher in the elderly patients (2.3% vs. 0.7%; P = 0.03). Aged patients also had a significantly higher incidence of vascular and bleeding complications. Blood transfusion was required more often in the elderly group (4.5% vs. 2.6%; P = 0.07). The hospitalization length was significantly higher in the elderly group (4.1 +/- 6.0 vs. 2.5 +/- 4.3 day; P = 0.0004). By multivariate logistic regression (adjusted for baseline clinical and angiographic variables), age > or = 75 years was found to be an independent predictor of in-hospital cardiac death (odds ratio = 3.9; 95% CI = 1.3-11.5; P = 0.015). Although PCI is technically successful in patients aged > or = 75 years; it is associated with more acute cardiac and vascular complications and higher in-hospital cardiac mortality.

Publication types

  • Comparative Study

MeSH terms

  • Age Factors
  • Aged
  • Aged, 80 and over
  • Angioplasty, Balloon, Coronary / mortality*
  • Blood Vessel Prosthesis Implantation
  • Coronary Angiography
  • Coronary Disease / complications
  • Coronary Disease / mortality*
  • Coronary Disease / therapy*
  • Death
  • Female
  • Hospital Mortality
  • Humans
  • Incidence
  • Length of Stay
  • Male
  • Middle Aged
  • Myocardial Infarction / complications
  • Myocardial Infarction / mortality
  • Myocardial Infarction / therapy
  • Platelet Glycoprotein GPIIb-IIIa Complex / antagonists & inhibitors
  • Platelet Glycoprotein GPIIb-IIIa Complex / therapeutic use
  • Postoperative Complications / etiology*
  • Postoperative Complications / mortality*
  • Predictive Value of Tests
  • Retrospective Studies
  • Risk Factors
  • Stents
  • Treatment Outcome

Substances

  • Platelet Glycoprotein GPIIb-IIIa Complex