Outcomes of PCI in Nonagenarians

Jul 06, 2017
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Authors:
Sawant AC, Josey K, Plomondon ME, et al.
Citation:
Temporal Trends, Complications, and Predictors of Outcomes Among Nonagenarians Undergoing Percutaneous Coronary Intervention: Insights From the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program. JACC Cardiovasc Interv 2017;10:1295-1303.
Summary By:
Hitinder S. Gurm, MBBS, FACC

Study Questions:

What are the temporal trends and complications of percutaneous coronary intervention (PCI) in nonagenarians?

Methods:

The authors assessed the outcome of all veterans undergoing PCI whose data were recorded in the Veterans Affairs Clinical Assessment, Reporting, and Tracking program from 2005 to 2014. Temporal trends in the use of PCI, occurrence of in-laboratory complications, and 30-day and 1-year mortality were assessed in nonagenarians versus younger patients.

Results:

Among a total of 67,148 veterans undergoing PCI between 2005 and 2014, 274 (0.4%) were nonagenarians. The proportion of nonagenarians increased from 0.25% in 2008 to 0.58% in 2014. Nonagenarians were more likely to undergo PCI for ST-segment elevation myocardial infarction (STEMI) and non-STEMI and were at a greater risk for post-procedure shock (0.73% vs. 0.12%; p = 0.04), no reflow (2.9% vs. 1.0%; p = 0.02), and 30-day mortality (10.6% vs. 1.4%; p < 0.0001). The risk of adjusted 30-day mortality (odds ratio, 2.14; 95% confidence interval [CI], 1.42-3.22) and 1-year mortality (16.3% vs. 4.2%; p < 0.0001, adjusted odds ratio, 1.82; 95% CI, 1.27-2.62) were higher among nonagenarians.

Conclusions:

Nonagenarians make up a small, but growing cohort of patients undergoing PCI. They are at higher risk of procedural complications and have a worse 30-day and 1-year mortality.

Perspective:

With the increasing human life span, the elderly and very elderly increasingly make up a small, but growing proportion of patients presenting to the catheterization laboratory. This study adds to the growing body of data supporting the safety of PCI in nonagenarians (see From AM, et al., JACC Cardiovasc Interv 2008;1:692-8, and Thomas MP, et al., Clin Cardiol 2011;34:549-54).

Keywords: Acute Coronary Syndrome, Aged, 80 and over, Catheterization, Geriatrics, Mortality, Myocardial Infarction, Outcome Assessment, Health Care, Percutaneous Coronary Intervention, Risk, Shock, Veterans


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