Key result
Elderly patients undergoing nonemergency PCI had a higher risk of major adverse cardiovascular events within 30 days compared to younger patients.
Why the study?
Does nonemergency PCI in elderly patients (age ≥75 years) compared to younger patients carry a higher risk of major adverse cardiovascular events within 30 days?
Cohort (n=31,758)
Yes
Does nonemergency PCI in elderly patients (age ≥75 years) compared to younger patients carry a higher risk of major adverse cardiovascular events within 30 days?
Elderly patients undergoing nonemergency PCI have a higher risk of 30-day periprocedural complications compared to younger patients, but this risk has not increased over time despite a growing proportion of elderly patients with multiple comorbidities.
Answers are grounded in this paper and cite their sources.
May warrant heightened periprocedural vigilance in elderly nonemergency PCI patients; leaves open whether targeted strategies improve outcomes.
BACKGROUND: The elderly account for an increasing proportion of the population and have a high prevalence of coronary heart disease. Percutaneous coronary intervention (PCI) is the most common method of revascularization in the elderly. We examined whether the risk of periprocedural complications after PCI was higher among elderly (age > or =75 years) patients and whether it has changed over time. METHODS AND RESULTS: The Scottish Coronary Revascularization Register was used to undertake a retrospective cohort study on all 31 758 patients undergoing nonemergency PCI in Scotland between April 2000 and March 2007, inclusive. There was an increase in the number and percentage of PCIs undertaken in elderly patients, from 196 (8.7%) in 2000 to 752 (13.9%) in 2007. Compared with younger patients, the elderly were more likely to have multivessel disease, multiple comorbidity, and a history of myocardial infarction or coronary artery bypass grafting (chi(2) tests, all P<0.001). The elderly had a higher risk of major adverse cardiovascular events within 30 days of PCI (4.5% versus 2.7%, chi(2) test P<0.001). Over the 7 years, there was a significant increase in the proportion of elderly patients who had multiple comorbidity (chi(2) test for trend, P<0.001). Despite this, the underlying risk of complications did not change significantly over time either among the elderly (chi(2) test for trend, P=0.142) or overall (chi(2) test for trend, P=0.083). CONCLUSIONS: Elderly patients have a higher risk of periprocedural complications and account for an increasing proportion of PCIs. Despite this, the risk of complications after PCI has not increased over time.
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Johnman et al. (2010) conducted a cohort in Coronary heart disease requiring nonemergency PCI (n=31,758). Nonemergency percutaneous coronary intervention in elderly patients (≥75 years) vs. Younger patients (<75 years) was evaluated on Major adverse cardiovascular events within 30 days of PCI (p=<0.001). Elderly patients undergoing nonemergency PCI had a higher risk of major adverse cardiovascular events within 30 days compared to younger patients.
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