Key result
DES-PCI in octogenarians linked to ~91% higher major cardiovascular events risk compared to younger patients.
Why the study?
Studies demonstrating the feasibility and clinical outcomes of PCI using drug-eluting stents in extremely aged patients are lacking.
Does age ≥80 years worsen clinical outcomes in patients undergoing PCI with drug-eluting stents compared to younger patients?
Cohort (n=1,089)
No
Does age ≥80 years worsen clinical outcomes in patients undergoing PCI with drug-eluting stents compared to younger patients?
Octogenarians undergoing PCI with DES have comparable angiographic outcomes but higher short- and long-term MACE and mortality compared to younger patients, likely due to a higher baseline clinical risk profile.
Answers are grounded in this paper and cite their sources.
Higher MACE rates in octogenarians warrant individualized risk assessment; leaves open whether DES-PCI improves net outcomes in this high-risk group.
Background and Objectives: In this current era of using drug-eluting stents (DES), studies that demonstrate the feasibility and clinical outcome of percutaneous coronary intervention (PCI) using DES in a subset of extremely aged patients are lacking. We investigated the clinical characteristics, therapeutic and clinical outcomes of patients older than 80 years that had been implanted with DES during a PCI. Subjects and Methods: Fifty-three “octogenarian” patients (≥80-years-old) and 1036 “non-octogenarian” patients (<80-years-old) that had been implanted with DES at Chonbuk National University Hospital since March 2003 were enrolled in the study. Medical records of the patients in the two groups were retrospectively reviewed. Results: The mean ages of the patients in the two groups were 83±2 years and 62±11 years, respectively, and the mean follow-up period was 15.8±10.9 months and 21.1±10.8 months, respectively. The octogenarian group showed an increased prevalence of female patients (58.5% vs. 35.1%, p=0.001), acute coronary syndrome (98.1% vs. 78.6%, p=0.001), ST-segment elevation myocardial infarction (41.5% vs. 28.3%, p=0.003), shock (17.0% vs. 6.6%, p=0.004), heart failure (22.6% vs. 9.3%, p=0.002) and a higher in-hospital major adverse cardiac event (MACE) rate (13.2% vs. 3.5%, p=0.004) than the non-octogenarian patients. Angiographic restenosis and target lesion revascularization rates were not different in both groups, but overall MACE (18.9% vs. 9.9%, p=0.035) and all-cause mortality (p<0.001) rates were significantly higher in the octogenarian group of patients. Conclusion: Although angiographic followup results were comparable in octogenarians and non-octogenarians, the occurrence of shortand long-term MACE was significantly higher in the very elderly group owing to a substantial subset of high-risk patients. (Korean Circ J 2007;37:647-655)
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Lee et al. (2007) conducted a cohort in Coronary artery disease requiring PCI (n=1,089). Age ≥80 years (Octogenarians) vs. Age <80 years (Non-octogenarians) was evaluated on Overall major adverse cardiac events (MACE) (p=0.035). Octogenarians undergoing PCI with drug-eluting stents had a higher rate of overall major cardiovascular events compared to non-octogenarians.
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