Key result
Among octogenarians undergoing PCI, hospital mortality was 26% for AMI, 3.6% for UAP, and 0% for SAP, with cardiogenic shock being the strongest predictor of mortality (OR 42, P=0.03).
Why the study?
What are the acute and intermediate-term clinical outcomes of percutaneous coronary stenting in octogenarian patients across different clinical presentations?
Cohort (n=97)
No
What are the acute and intermediate-term clinical outcomes of percutaneous coronary stenting in octogenarian patients across different clinical presentations?
Odds Ratio: 42
p-value: p=0.03
PCI in octogenarians has favorable outcomes for stable and unstable angina, but carries high mortality in acute myocardial infarction, particularly when complicated by cardiogenic shock.
May inform risk discussions for PCI in octogenarians; leaves open optimal strategies in contemporary elderly cohorts.
BACKGROUND: Percutaneous coronary intervention (PCI) in octogenarian patients has been associated with increased cardiovascular morbidity and mortality. This study aimed to assess acute and intermediate-term clinical outcomes among octogenarians undergoing PCI. METHODS: The authors identified 97 consecutive patients aged > or =80 years who underwent PCI using stents between November 2000 and February 2002 at their institution. The patients were divided into three groups according to clinical presentation: (1) acute myocardial infarction (AMI, n = 31); (2) unstable angina pectoris (UAP, n = 28); and (3) stable angina pectoris (SAP, n = 38). Procedural data, and in-hospital and six-month clinical outcomes were obtained and adjudicated for all patients. RESULTS: Overall mean age was 84 +/- 3 years, 67% of patients were males and 73% had multivessel coronary disease. In-hospital outcomes varied according to clinical presentation: procedural success was 78% in AMI patients (including shock patients), 93% in UAP, and 95% in SAP patients. Likewise, hospital mortality was 26% in AMI, 3.6% in UAP, and 0% in SAP patients (p = 0.0003). Among AMI patients, hospital mortality was extremely high in patients with cardiogenic shock (67% versus 4.6% in AMI without shock, p < 0.0001). Cumulative event rate at six months also varied according to clinical presentation: mortality/MI and target vessel revascularization (TVR) rates were 29%, 3.6%, and 0% in AMI, 7.1%, 7.4%, and 11% in UAP and 0%, 5.3%, and 7.9% in SAP patients. Multivariate analysis identified cardiogenic shock as the most powerful risk factor for predicting mortality (odds ratio = 42, p = 0.03). CONCLUSIONS: These results show that clinically stable octogenarian patients undergoing PCI have favorable procedural and intermediate-term prognosis. In contrast, cardiogenic shock has a profound negative prognostic impact on octogenarians despite 'aggressive' PCI attempts.
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Teplitsky et al. (2003) conducted a cohort in Coronary artery disease (n=97). Percutaneous coronary intervention (PCI) vs. Different clinical presentations (AMI vs UAP vs SAP) was evaluated on Hospital mortality predicted by cardiogenic shock (OR 42, p=0.03). Among octogenarians undergoing PCI, hospital mortality was 26% for AMI, 3.6% for UAP, and 0% for SAP, with cardiogenic shock being the strongest predictor of mortality (OR 42, P=0.03).