title: Acute and intermediate-term results of percutaneous coronary stenting in octogenarian patients.
abstract: 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.
authors: Cardiology Department, Rabin Medical Center, Petch-Tivka, Israel.
authors: Igal
authors: I
authors: Teplitsky
authors: Abid
authors: A
authors: Assali
authors: Gregory
authors: G
authors: Golovchiner
authors: Nurit
authors: N
authors: Shor
authors: Avraham
authors: A
authors: Weiss
authors: Alexander
authors: A
authors: Battler
authors: Ran
authors: R
authors: Kornowski
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000401:mortality / Q000628:therapy*; D000789:Angina, Unstable / Q000401:mortality / Q000628:therapy*; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D011379:Prognosis; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000401:mortality; D015607:Stents; D016896:Treatment Outcome