Percutaneous coronary intervention for older adults who present with syncope and coronary artery disease? Insights from the National Cardiovascular Data Registry.
We explored the risks/benefits of revascularization versus medical management in syncope patients with obstructive coronary artery disease (CAD).



We retrospectively examined Medicare patients ≥65 years undergoing percutaneous coronary intervention (PCI) for syncope at 539 CathPCI Registry hospitals with ≥70% stenosis in at least 1 coronary artery, excluding those with ST-segment elevation myocardial infarction (MI), cardiogenic shock, left main disease, and coronary artery bypass grafting. In a propensity-matched population, we compared short-term (90-day) all-cause readmission risk and long-term (3-year) risks of readmission for syncope and MI, as well as mortality in those receiving PCI versus medical management.



Among 14,674 syncope patients, 9,549 (65%) had at least 1-vessel obstructive CAD. After exclusions, 3,196 of 7,338 patients (44%) underwent PCI. In the propensity-matched cohort, there was no significant difference in 90-day all-cause readmission risk (28.2% vs 30.3%, adjusted hazard ratio [HR] 0.92, 95% CI 0.83-1.02) or long-term risks of readmission for syncope (7.0% vs 6.1%, adjusted HR 1.06, 95% CI 0.83-1.35). PCI-treated patients had significantly higher risk of readmission for MI (5.6% vs 4.0%, adjusted HR 1.56, 95% CI 1.18-2.06) but lower risk of long-term mortality (27.0% vs 30.3%, adjusted HR 0.86, 95% CI 0.77-0.97) than medically managed patients.



In patients presenting with syncope and obstructive CAD, PCI was not associated with significant improvements in the risk of readmission but was associated with lower long-term mortality compared with medical therapy, suggesting the need to more definitively assess the benefit of PCI among elderly syncope patients.
Duke Clinical Research Institute, Duke University Medical Center, Durham, NC.
Lindsay L
LL
Anderson
Duke Clinical Research Institute, Duke University Medical Center, Durham, NC.
David
D
Dai
Brigham and Women's Hospital, Boston, MA.
Amy Leigh
AL
Miller
Duke Clinical Research Institute, Duke University Medical Center, Durham, NC.
Matthew T
MT
Roe
University of Colorado, Denver, CO.
John C
JC
Messenger
Duke Clinical Research Institute, Duke University Medical Center, Durham, NC. Electronic address: tracy.wang@duke.edu.
Tracy Y
TY
Wang
D000368:Aged; D002317:Cardiovascular Agents / Q000627:therapeutic use; D017023:Coronary Angiography / Q000379:methods / Q000706:statistics & numerical data; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D003331:Coronary Vessels / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D010359:Patient Readmission / Q000706:statistics & numerical data; D062645:Percutaneous Coronary Intervention / Q000379:methods / Q000706:statistics & numerical data; D057216:Propensity Score; D012189:Retrospective Studies; D018570:Risk Assessment; D013575:Syncope / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D014481:United States / Q000453:epidemiology
D002317:Cardiovascular Agents