Key result
Percutaneous coronary intervention in octogenarians increased nearly ten-fold from 19 in 2007 to 178 in 2016, with no significant differences in adverse clinical outcomes over time.
Why the study?
Octogenarians have been underrepresented in randomised clinical trials of coronary revascularisation despite increasing demand for PCI in an ageing population.
Observational (n=782)
No
PCI use in octogenarians has increased significantly over a 10-year period without a corresponding increase in adverse clinical outcomes, supporting its safety and efficacy in this high-risk population.
PCI may be safe for octogenarians; leaves open need for RCTs to guide practice.
Background With an ageing population, the demand for percutaneous coronary intervention (PCI) in the elderly is on the rise. Technical advances, better peri-procedural pharmacology and greater operator experience have led to improved outcomes after PCI. Octogenarians as a group, however, have been underrepresented in randomised clinical trials of coronary revascularisation. Observational studies therefore provide useful insights into the safety and efficacy of PCI in this patient population in a real-world clinical practice. Aim The aim of this study was to examine the trends in patient characteristics and clinical outcomes after PCI in octogenarians over a 10-year period in a large non-surgical PCI centre and to determine the predictors of mortality in this high risk patient cohort. Methods A total of 782 consecutive octogenarians were identified from a prospectively collected database of all patients undergoing PCI at our centre between 2007 and 2016. We analysed the characteristics of the cohort with respect to all-cause in-hospital and 1-year mortality, in-hospital Major Adverse Cardiovascular Events (MACE) rates, complexity of coronary artery disease and major comorbidities. The patients were stratified into three chronological tertiles to assess differences over time. A multivariate analysis was performed to determine predictors of mortality. Results The number of octogenarians undergoing PCI was found to have increased nearly ten-fold, from 19 in 2007 to 178 in 2016. Despite this, there were no significant differences in adverse clinical outcomes. A greater use of radial access was noted (p<0.0001). Increasing age, the presence of cardiogenic shock, severe left ventricular impairment, peripheral vascular disease, diabetes mellitus and low creatinine clearance were identified as independent predictors of mortality after PCI (Table 1). Conclusion PCI in octogenarians is a safe and effective revascularisation option, the use of which is increasing in the real-world clinical practice. Future PCI randomised clinical trials should include this challenging cohort to enhance the evidence base. Funding Acknowledgement Type of funding source: None
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Abramik et al. (2020) conducted an observational in Coronary artery disease (n=782). Percutaneous coronary intervention was evaluated on All-cause in-hospital and 1-year mortality, and in-hospital Major Adverse Cardiovascular Events (MACE). Percutaneous coronary intervention in octogenarians increased nearly ten-fold from 19 in 2007 to 178 in 2016, with no significant differences in adverse clinical outcomes over time.
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