Safety of Contemporary Percutaneous Peripheral Arterial Interventions in the Elderly: Insights From the BMC2 PVI (Blue Cross Blue Shield of Michigan Cardiovascular Consortium Peripheral Vascular Intervention) Registry

Study Questions:

What is the effect of age on procedure type, periprocedural management, and in-hospital outcomes of patients undergoing lower-extremity (LE) peripheral vascular intervention (PVI)?

Methods:

Clinical presentation, comorbidities, and in-hospital outcomes of patients undergoing LE PVI in a multicenter, multidisciplinary registry were compared between three age groups: <70 years, between 70 and 80 years, and ≥80 years (elderly group).

Results:

A cohort of 7,769 patients underwent LE PVI. Elderly patients were more likely to be female and to have a greater burden of comorbidities. Procedural success was lower in the elderly group (74.2% for age ≥80 years vs. 78% for ages 70-80 years, and 81.4% in patients ages <70 years, respectively; p < 0.0001). Unadjusted rates of procedure-related vascular access complications, post-procedure transfusion, contrast-induced nephropathy, amputation, and major adverse cardiac events were higher in elderly patients. After adjustment for baseline covariates, the elderly patients were more likely to experience vascular access complications; however, advanced age was not found to be associated with major adverse cardiac events, transfusion, contrast-induced nephropathy, or amputation.

Conclusions:

The authors concluded that contemporary PVI can be performed in elderly patients with high procedural and technical success, with low rates of periprocedural complications including mortality.

Perspective:

In this prospective registry of patients undergoing PVI, elderly patients, as defined by age ≥80 years, had more pre-existing comorbidities including hypertension, congestive heart failure, and cardiovascular disease/transient ischemic attack, as well as more frequent baseline anemia. Unadjusted rates of periprocedural complications were higher in the ≥80-year group, but these associations were not significant after multivariate adjustment. Overall, the data suggest that contemporary PVI can be performed in elderly patients with high procedural and technical success with a very low overall incidence of adverse events and acceptably low mortality rates, and support the use of PVI as the preferred method of revascularization in the treatment of severe peripheral arterial disease in the elderly population.

Clinical Topics: Heart Failure and Cardiomyopathies, Vascular Medicine, Atherosclerotic Disease (CAD/PAD), Acute Heart Failure

Keywords: Registries, Michigan, Ischemic Attack, Transient, Heart Failure, Blue Cross Blue Shield Insurance Plans, Peripheral Arterial Disease, Peripheral Vascular Diseases


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