Key result
PCI linked to lower 3-year mortality vs medical management in elderly ACS patients.
Why the study?
Does percutaneous coronary intervention improve short- and long-term survival in elderly patients presenting with acute coronary syndrome compared to conservative management?
Cohort (n=491)
Yes
Does percutaneous coronary intervention improve short- and long-term survival in elderly patients presenting with acute coronary syndrome compared to conservative management?
In real-world elderly patients (≥70 years) with ACS, PCI is associated with significantly better short- and long-term survival compared to conservative medical management, even after matching for baseline risk.
Answers are grounded in this paper and cite their sources.
PCI associated with lower mortality in elderly ACS; leaves open whether it improves outcomes in randomized trials.
BACKGROUND: Percutaneous coronary intervention (PCI) are increasingly used in daily clinical practice in elderly patients with acute coronary syndrome (ACS) despite limited evidence. The purpose of this study was to assess the impact of PCI on short and long term survivals in a large cohort of elderly patients with ACS from a "real world". METHODS: We enrolled 491 patients aged ≥70 years admitted to our institution with ACS from 2006 to 2012. Effect of PCI on short and long term survival was evaluated in both overall and a propensity score-matched cohort. RESULTS: The mean age of the overall cohort is 83 ± 6 years. Among them, 285 were treated with PCI, whereas 206 were not. Patients treated with PCI were younger (82 ± 5 vs. 85 ± 6), more males (67% vs. 46%), with lower heart rate (77 ± 22 vs. 84 ± 21), higher eGFR (58 ± 20 vs. 47 ± 23), and less with heart failure (29% vs. 15%) (all p < 0.001). In both overall and propensity-matched population, improved survival was associated with PCI-treatment at 1 and 3 years (p < 0.001 for all comparisons). Furthermore, by using multivariate Cox proportional-hazards regression model following factors were identified as independent predictors of 3-year all-cause mortality: age (HR 1.08, 95% CI 1.00-1.16), heart rate (HR 1.02, 95% CI 1.01-1.03), eGFR (HR 3.07, 95% CI 1.63-5.77), malignancy (HR 2.03, 95% CI 1.27-4.57), prior CABG (HR 2.033, 95% CI 1.27-4.57), medication with statin (HR 0.40, 95% CI 0.19-0.86) in PCI group, whereas age (HR 1.08, 95% CI 1.03-1.13), heart rate (HR 1.01, 95% CI 1.01-1.02), hypertension (HR 1.87, 95% CI 1.01-3.49) and using of ACEI/ARB (HR 0.46, 95% CI 0.28-0.76) in non-PCI group. CONCLUSIONS: In elderly ACS patients, PCI-treatment was associated with improved 1 and 3-year survival and PCI-treated patients had different prognostic profile compared to those without PCI treatment.
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Chen et al. (2018) conducted a cohort in Acute coronary syndrome (ACS) (n=491). Percutaneous coronary intervention (PCI) vs. Conservative medical management (Non-PCI) was evaluated on 3-year all-cause mortality (propensity-matched cohort) (HR 1.879, 95% CI 1.286-2.745, p=0.001). In a propensity-matched cohort of elderly patients with ACS, percutaneous coronary intervention was associated with lower 3-year all-cause mortality compared to medical management.
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