Percutaneous coronary intervention in the elderly: changes in case-mix and periprocedural outcomes in 31,758 patients treated between 2000 and 2007.
BACKGROUND
The elderly account for an increasing proportion of the population and have a high prevalence of coronary heart disease. Percutaneous coronary intervention (PCI) is the most common method of revascularization in the elderly. We examined whether the risk of periprocedural complications after PCI was higher among elderly (age > or =75 years) patients and whether it has changed over time.


RESULTS
The Scottish Coronary Revascularization Register was used to undertake a retrospective cohort study on all 31 758 patients undergoing nonemergency PCI in Scotland between April 2000 and March 2007, inclusive. There was an increase in the number and percentage of PCIs undertaken in elderly patients, from 196 (8.7%) in 2000 to 752 (13.9%) in 2007. Compared with younger patients, the elderly were more likely to have multivessel disease, multiple comorbidity, and a history of myocardial infarction or coronary artery bypass grafting (chi(2) tests, all P<0.001). The elderly had a higher risk of major adverse cardiovascular events within 30 days of PCI (4.5% versus 2.7%, chi(2) test P<0.001). Over the 7 years, there was a significant increase in the proportion of elderly patients who had multiple comorbidity (chi(2) test for trend, P<0.001). Despite this, the underlying risk of complications did not change significantly over time either among the elderly (chi(2) test for trend, P=0.142) or overall (chi(2) test for trend, P=0.083).


CONCLUSIONS
Elderly patients have a higher risk of periprocedural complications and account for an increasing proportion of PCIs. Despite this, the risk of complications after PCI has not increased over time.
Johnman
Cathy
C
Public Health, University of Glasgow, United Kingdom.
Oldroyd
Keith G
KG
Mackay
Danny F
DF
Slack
Rachel
R
Pell
Alastair C H
AC
Flapan
Andrew D
AD
Jennings
Kevin P
KP
Eteiba
Hany
H
Irving
John
J
Pell
Jill P
JP
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty; D015897:Comorbidity; D003327:Coronary Disease / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D020379:Risk Adjustment; D016896:Treatment Outcome