title: Comparison of the Effects of Incomplete Revascularization on 12-Month Mortality in Patients <80 Compared With ≥80 Years Who Underwent Percutaneous Coronary Intervention.
abstract: Although randomized trial data suggest that complete revascularization improves outcomes after percutaneous coronary intervention (PCI), the impact of differing revascularization strategies in octogenarians is not well defined. We performed a retrospective analysis, which was conducted of 9,628 consecutive patients who underwent PCI at a large UK center. Octogenarians were more likely to have significant co-morbidity, a higher Mehran bleed risk score (24.5 ± 6.8 vs 13.3 ± 7.4, p <0.0001), and more complex disease (baseline SYNTAX score 18.7 ± 11.0 vs 13.1 ± 8.9, p = 0.002) than younger patients. During PCI, octogenarians were more likely to undergo left main or proximal LAD intervention, but despite this, significantly less likely to receive drug-eluting stents (66.5% vs 80.1%, p <0.001). Postprocedurally, octogenarians had greater residual disease burden (residual SYNTAX score 10.1 ± 8.7 vs 1.6 ± 3.3, p <0.0001). At 12 months, adverse outcomes (definite stent thrombosis 3.3% vs 1.1%, p <0.001, clinically driven in-stent restenosis PCI 3.7% vs 2.6%, p = 0.005, and 12-month mortality 12.8% vs 4.2%, p <0.0001) were all more frequent in octogenarians. Although age, shock, diabetes, and BMS use were independently predictive of increased 12-month mortality, incomplete revascularization was not. In conclusion, octogenarians are a complex group to treat balancing high-risk bleeding profile and complex coronary disease. However, in multivariate analysis, incomplete revascularization was not independently predictive of adverse outcomes. These data support a conservative target lesion-only DES-driven revascularization strategy.
authors.affiliation: Department of Cardiology, University Hospital of Wales, Heath Park, Cardiff, United Kingdom.
authors.forename: Khaled
authors.initials: K
authors.lastname: Yazji
authors.affiliation: Department of Cardiology, University Hospital of Wales, Heath Park, Cardiff, United Kingdom.
authors.forename: Fairoz
authors.initials: F
authors.lastname: Abdul
authors.affiliation: Department of Cardiology, University Hospital of Wales, Heath Park, Cardiff, United Kingdom.
authors.forename: Senthil
authors.initials: S
authors.lastname: Elangovan
authors.affiliation: Department of Cardiology, University Hospital of Wales, Heath Park, Cardiff, United Kingdom.
authors.forename: Nick
authors.initials: N
authors.lastname: Ossei-Gerning
authors.affiliation: Department of Cardiology, University Hospital of Wales, Heath Park, Cardiff, United Kingdom.
authors.forename: Anirban
authors.initials: A
authors.lastname: Choudhury
authors.affiliation: Department of Cardiology, Royal Sussex County Hospital Brighton, United Kingdom.
authors.forename: James
authors.initials: J
authors.lastname: Cockburn
authors.affiliation: Department of Cardiology, University Hospital of Wales, Heath Park, Cardiff, United Kingdom.
authors.forename: Richard
authors.initials: R
authors.lastname: Anderson
authors.affiliation: Institute for Science and Technology, Keele University, Stoke-on-Trent, United Kingdom.
authors.forename: Mamas
authors.initials: M
authors.lastname: Mamas
authors.affiliation: Department of Cardiology, University Hospital of Wales, Heath Park, Cardiff, United Kingdom. Electronic address: tim.kinnaird2@wales.nhs.uk.
authors.forename: Tim
authors.initials: T
authors.lastname: Kinnaird
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery*; D023921:Coronary Stenosis / Q000453:epidemiology / Q000401:mortality / Q000601:surgery*; D054855:Drug-Eluting Stents; D005260:Female; D006083:Graft Occlusion, Vascular / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009026:Mortality; D062645:Percutaneous Coronary Intervention; D019106:Postoperative Hemorrhage / Q000453:epidemiology; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology; D012189:Retrospective Studies; D012769:Shock / Q000453:epidemiology; D012907:Smoking / Q000453:epidemiology; D015607:Stents; D006113:United Kingdom / Q000453:epidemiology