In-hospital and long-term outcomes after percutaneous coronary intervention for chronic total occlusion in elderly patients: A consecutive, prospective, single-centre study.
BACKGROUND
Elderly patients are increasingly referred for complex percutaneous coronary interventions (PCI), including recanalization of chronic total occlusion (CTO).


OBJECTIVE
To assess the feasibility, safety and clinical benefits associated with CTO-PCI in elderly patients.


METHODS
Consecutive patients (n=356) who underwent CTO-PCI in our institution between January 2008 and December 2011 were prospectively included. The short-term outcomes of CTO-PCI were assessed by comparing the rates of successful recanalization and postoperative complications in patients aged ≥ 75 years and those < 75 years. The clinical effect of successful recanalization was evaluated in a 20-month follow-up analysis in patients ≥ 75 years.


RESULTS
Although patients ≥ 75 years (n = 93) had more complex coronary artery disease, the procedural success rate was similar to that in younger patients (78.2% vs. 74.3%, respectively; P = 0.41). Postoperative complications were more frequent in older patients (5.4% vs. 0.4%; P = 0.005). Major adverse cardiac event-free survival analysis at 20 months revealed that successful revascularization was indicative of a better prognosis in older patients (hazard ratio: 0.43, 95% confidence interval: 0.19-0.96; P = 0.039).


CONCLUSIONS
Elderly patients have more complex coronary disease and are at a higher risk of postoperative complications. Nevertheless, we observed a similar success rate for CTO-PCI in elderly patients as for younger patients. Successful CTO recanalization improved the event-free survival rate at 20 months. Thus, CTO-PCI constitutes an alternative strategy for treating selected elderly patients.
Cardiology Department, Rangueil University Hospital, 31059 Toulouse cedex 9, France.
Romain
R
André
Cardiology Department, Rangueil University Hospital, 31059 Toulouse cedex 9, France.
Nicolas
N
Dumonteil
Cardiology Department, Rangueil University Hospital, 31059 Toulouse cedex 9, France.
Thibault
T
Lhermusier
Cardiology Department, Rangueil University Hospital, 31059 Toulouse cedex 9, France.
Olivier
O
Lairez
Cardiology Department, Rangueil University Hospital, 31059 Toulouse cedex 9, France.
Jérôme
J
Van Rothem
Cardiology Department, Rangueil University Hospital, 31059 Toulouse cedex 9, France.
Pauline
P
Fournier
Cardiology Department, Rangueil University Hospital, 31059 Toulouse cedex 9, France.
Meyer
M
Elbaz
Cardiology Department, Rangueil University Hospital, 31059 Toulouse cedex 9, France.
Didier
D
Carrié
Cardiology Department, Rangueil University Hospital, 31059 Toulouse cedex 9, France. Electronic address: boudou.n@chu-toulouse.fr.
Nicolas
N
Boudou
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D054059:Coronary Occlusion / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D018572:Disease-Free Survival; D005240:Feasibility Studies; D005260:Female; D005602:France; D006760:Hospitalization; D006785:Hospitals, University; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D018579:Patient Selection; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
Age; Angioplastie; Chronic total occlusion; Occlusion coronaire chronique; Outcomes; Percutaneous coronary intervention; Pronostic; Âgés