title: The dilemma of success: percutaneous coronary interventions in patients > or = 75 years of age-successful but associated with higher vascular complications and cardiac mortality.
abstract: Elderly patients are increasingly referred to percutaneous coronary interventions (PCIs). Recent reports suggest complications rates are declining in the elderly. We sought to determine whether procedural and in-hospital outcomes are different in patients aged > or = 75 years undergoing nonemergent PCI as compared to patients age < 75 years. The outcome of 266 consecutive patients age > or = 75 years undergoing nonemergent PCI was compared to that of 1,681 consecutive patients age < 75 years. Compared with younger patients, greater proportions of elderly patients were women and had a history of hypertension, peripheral vascular disease, and cerebral vascular events. Elderly patients had more extensive coronary involvement. Procedural success was similar in both groups (94%). The in-hospital cardiac death rate was significantly higher in the elderly patients (2.3% vs. 0.7%; P = 0.03). Aged patients also had a significantly higher incidence of vascular and bleeding complications. Blood transfusion was required more often in the elderly group (4.5% vs. 2.6%; P = 0.07). The hospitalization length was significantly higher in the elderly group (4.1 +/- 6.0 vs. 2.5 +/- 4.3 day; P = 0.0004). By multivariate logistic regression (adjusted for baseline clinical and angiographic variables), age > or = 75 years was found to be an independent predictor of in-hospital cardiac death (odds ratio = 3.9; 95% CI = 1.3-11.5; P = 0.015). Although PCI is technically successful in patients aged > or = 75 years; it is associated with more acute cardiac and vascular complications and higher in-hospital cardiac mortality.
authors.affiliation: Cardiac Catheterization Laboratory, Rabin Medical Center, Petach-Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. aassali@netvision.net.il
authors.forename: Abid R
authors.initials: AR
authors.lastname: Assali
authors.forename: Ali
authors.initials: A
authors.lastname: Moustapha
authors.forename: Stefano
authors.initials: S
authors.lastname: Sdringola
authors.forename: Joseph
authors.initials: J
authors.lastname: Salloum
authors.forename: Hany
authors.initials: H
authors.lastname: Awadalla
authors.forename: Sangeeta
authors.initials: S
authors.lastname: Saikia
authors.forename: Mohammad
authors.initials: M
authors.lastname: Ghani
authors.forename: Susan
authors.initials: S
authors.lastname: Hale
authors.forename: G
authors.initials: G
authors.lastname: Schroth
authors.forename: Oscar
authors.initials: O
authors.lastname: Rosales
authors.forename: H Vernon
authors.initials: HV
authors.lastname: Anderson
authors.forename: Richard W
authors.initials: RW
authors.lastname: Smalling
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000401:mortality*; D019917:Blood Vessel Prosthesis Implantation; D017023:Coronary Angiography; D003327:Coronary Disease / Q000150:complications / Q000401:mortality* / Q000628:therapy*; D003643:Death; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality / Q000628:therapy; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors / Q000627:therapeutic use; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome
chemical_list: D019039:Platelet Glycoprotein GPIIb-IIIa Complex