36 Complex disease, partial revascularisation and adverse outcomes in elderly patients undergoing PCI

Abstract

IntroductionElderly patients (≥80years) represent an increasingly large sub-group of patients undergoing percutaneous coronary intervention (PCI). However their characteristics and outcomes are not well defined.MethodsA retrospective analysis was conducted of all patients who underwent PCI at a large UK cardiac centre between 2008 and 2014.Results9,628 patients underwent PCI with the mean age increasing from 62.4 ± 11.4yrs in 2008 to 64.8 ± 11.8yrs in 2014. Elderly patients were more likely to be female, have severe LV dysfunction, and more likely to have significant comorbidity than younger patients. Elderly patients had a higher Mehran bleed risk score (24.5 ± 6.8 vs. 13.3 ± 7.4, p < 0.0001), more complex disease with higher baseline SYNTAX score (18.7 ± 11.0 vs. 13.1 ± 8.9, p = 0.002), a greater incidence of left main or proximal LAD disease, and more vessels diseased. During PCI the elderly were more likely to undergo left main or proximal LAD intervention but significantly less likely to receive a BMS (34.5 vs. 19.9%, p < 0.001). The elderly cohort had greater residual disease burden (residual SYNTAX 10.1 ± 8.7 vs. 1.6 ± 3.3, p < 0.0001) and a greater likelihood of adverse outcomes (definite stent thrombosis 2.1 vs. 3.3%, p = 0.017, clinically driven ISRS-PCI 3.7 vs. 2.6%, p = 0.036, and mortality 12.8 vs. 4.2%, p < 0.0001) at 12-months.ConclusionsElderly patients represent an increasingly large cohort of patients requiring PCI, have increased comorbidity and complex coronary disease, and are more likely to receive incomplete revascularisation, BMS and have adverse 12-month outcomes.