[Percutaneous coronary interventions in elderly patients: clinical indications and adjunctive medical treatment. The Italian Drug Evaluation in Angioplasty (IDEA) study].
BACKGROUND
Specific guidelines for interventional cardiology in elderly patients are not available, and it appears that aged patients are treated more conservatively. Nevertheless data on the real clinical practice are lacking. The aim of the study was to describe different therapeutic strategies in elderly patients enrolled in the Italian Drug Evaluation in Angioplasty (IDEA) study.


METHODS
The IDEA study is a registry of consecutive percutaneous coronary interventions (PCI) performed from September 15 to 29, 2003, at 79 Italian cath-labs.


RESULTS
Out of 1517 consecutive PCI patients, 491 (32%) were aged > or = 70 years. Compared to younger patients, those > or = 70 years old showed more frequently (p < 0.001) renal insufficiency (10.4 vs 4.4%), peripheral vasculopathy (18 vs 6.9%), history of stroke (7.3 vs 3.3%) or previous surgical coronary revascularization (15 vs 7.5%) and multivessel disease (61 vs 49%). In patients aged > or = 70 years, acute coronary syndrome was the more frequent clinical indication for PCI (54 vs 49% in patients < 70 years, p = 0.05). Globally, stent use was 89% with no differences related to the patients' age. Drug-eluting stents were used in 21% of the procedures in elderly patients and in 22% in younger patients. Use of glycoprotein IIb/IIIa receptor antagonists in acute coronary syndrome was not correlated with the patients' age; nevertheless in elderly patients with acute myocardial infarction these drugs were less used during primary angioplasty compared to younger patients (48 vs 72%, p = 0.001). In-hospital mortality was higher in patients aged > or = 70 years (2.9 vs 0.9%, p = 0.004), particularly in patients treated for acute coronary syndromes (5.5 vs 1.4%, p = 0.002). In these patients, more bleeding complications (7.1 vs 3.9%, p < 0.001) and heart failure (5.5 vs 1.6%, p = 0.004) were observed.


CONCLUSIONS
Compared to younger patients, elderly patients enrolled in the IDEA study had a higher risk profile and higher in-hospital morbidity and mortality. Except for a lower use of glycoprotein IIb/IIIa receptor antagonists for acute myocardial infarction, no discriminations were observed in elderly patients in terms of clinical indications, antiplatelet therapy and drug-eluting stent use.
Bossi
Irene
I
Dipartimento Cardiovascolare A De Gasperis, Ospedale Niguarda Ca' Granda, Milano.
Piccaluga
Emanuela
E
Scatturin
Melania
M
Corvaja
Nicola
N
Pasquetto
Giampaolo
G
Steffanon
Luigi
L
Oberhollenzer
Rainer
R
Colombo
Paola
P
Bolognese
Leonardo
L
Savonitto
Stefano
S
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D003327:Coronary Disease / Q000188:drug therapy / Q000401:mortality* / Q000628:therapy*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy / Q000401:mortality / Q000517:prevention & control*; D009204:Myocardial Revascularization / Q000379:methods; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D015607:Stents; D016896:Treatment Outcome
D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex