Multicenter experience in revascularization of very elderly patients.
BACKGROUND
Very elderly patients are increasingly referred for revascularization yet have been underrepresented in both prior percutaneous coronary intervention (PCI) and coronary bypass surgery (CABG) clinical trials. We pooled the largest PCI and CABG clinical registries in the United States to better understand revascularization procedure use, risks and outcomes in patients aged > or =75 years.


METHODS
Six PCI registries (n = 48,439) and 8 CABG registries (n = 180,709) voluntarily contributed all procedural data in patients aged > or =75 years from 1990 through 1999. Patient characteristics, procedural process, and inhospital mortality and morbidity outcomes were evaluated. Risk factors for mortality in elderly patients were identified and compared across registries using standardized multivariable logistic regression.


RESULTS
Between the years 1991 and 1999, the proportion of patients aged > or =75 years undergoing revascularization was on the rise (10% increase). Pooled estimates of inhospital mortality following PCI during this decade was 3.0% (range 1.5%-5.2% among databases), and following CABG was 5.9% (range 4.9%-8.4% among databases). Mortality rates declined significantly in older patients for both PCI and CABG over this decade. While process measures varied across registries, the most significant predictors of inhospital death (procedural urgency, left ventricular dysfunction, prior CABG) seemed consistent across all sites.


CONCLUSIONS
Over the last decade, the use of coronary revascularization in elderly patients increased and outcomes improved. While age remains a determinant of procedural risk, this risk varies markedly among elderly patients, emphasizing the need for individualized risk assessments.
Peterson
Eric D
ED
The Outcomes Research and Assessment Group, The Duke Clinical Research Institute, Durham, NC 27715, USA. peter016@mc.duke.edu
Alexander
Karen P
KP
Malenka
David J
DJ
Hannan
Edward L
EL
O'Conner
Gerald T
GT
McCallister
Ben D
BD
Weintraub
William S
WS
Grover
Fred L
FL
D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000401:mortality / Q000706:statistics & numerical data*; D001026:Coronary Artery Bypass / Q000401:mortality / Q000706:statistics & numerical data*; D003327:Coronary Disease / Q000601:surgery / Q000628:therapy*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D012042:Registries; D014481:United States