Outcomes in octogenarians undergoing percutaneous coronary intervention: nationwide data from the Netherlands Heart Registration

Background In patients with coronary artery disease, age is of known significance in predicting outcomes. Data on clinical outcomes in patients ≥ 85 years undergoing percutaneous coronary intervention (PCI) remain scarce. The study aim was to determine clinical characteristics, risk of adverse cardiovascular events, and mortality in patients aged ≥ 85 years compared to those aged < 85 undergoing PCI. Methods In this retrospective study, data were obtained from the nationwide Netherlands Heart Registration on patients undergoing PCI between January 1st, 2017 and January 1st, 2021. The primary endpoint was all-cause mortality at long-term follow-up. Results A total of 155,683 patients underwent PCI, of which 100,209 (64.4%) acute coronary syndrome cases. Compared to patients aged < 85 years, patients aged ≥ 85 were more often female and showed a higher number of cardiovascular comorbidities, including impaired left ventricle ejection fraction and reduced kidney function. Mortality at short-term and long-term follow-up were significantly higher in those aged ≥ 85 (P < 0.001). Patients aged ≥ 85 were more likely to have a myocardial infarction within 30 days following the index intervention (0.9% vs. 0.7%; P = 0.024), though they less often underwent revascularization at long-term follow-up compared to patients aged < 85 (P < 0.001). Conclusions The elderly (≥ 85 years) patient requiring PCI carries an extensive cardiovascular risk profile, translating in significant risk of recurrent cardiovascular events and increased mortality rate. Clinicians should carefully weigh perceived risks and potential benefits in the individual patient, considering the patients’ age, cardiovascular risk profile, and associated risk of morbidity and mortality.