Acute coronary syndrome in octogenarians: association between percutaneous coronary intervention and long-term mortality

Abstract

AimEvidence of improved survival after use of percutaneous coronary intervention (PCI) in elderly patients with acute coronary syndrome (ACS) is limited. We assessed the association between PCI and long-term mortality in octogenarians with ACS.Methods and resultsWe followed 353 consecutive patients aged ≥80 years hospitalized with ACS during 2006–2007. Among them, 182 were treated with PCI, whereas 171 were not. PCI-treated patients were younger and more often male, and had less stroke and dependency in activities of daily living, but there were no significant differences in occurrence of diabetes mellitus, chronic obstructive pulmonary disease, hypertension, and uncured malignancies between the two groups. The association between PCI and all-cause mortality was assessed in the overall cohort and a 1:1 matched cohort based on propensity score (PS). In overall cohort, 5-year all-cause mortality was 46.2% and 89.5% in the PCI and non-PCI groups, respectively. Cox regression analysis in overall cohort by adjustment for ten baseline variables showed statistically significant association between PCI and reduced long-term mortality (P<0.001, hazard ratio 0.4, 95% confidence interval [CI] 0.2–0.5). In propensity-matched cohort, 5-year all-cause mortality was 54.9% and 83.1% in the PCI and non-PCI groups, respectively. Kaplan–Meier survival curves and log rank test showed significantly improved mean survival rates (P=0.001): 48 months (95% CI 41–54) for PCI-treated patients versus 35 months (95% CI 29–42) for non-PCI-treated patients. Furthermore, by performing Cox regression analysis, PCI was still associated with reduced long-term mortality (P=0.029, hazard ratio 0.5, 95% CI 0.3–0.9) after adjustment for PS and confounders: age, male sex, cognitive deterioration, uncured malignancies, left ventricular ejection fraction ≤45%, estimated glomerular filtration rate ≤35 mL/min, ST-segment elevation myocardial infarction, mitral regurgitation, and medication at discharge with clopidogrel and statins.ConclusionIn octogenarians with ACS, PCI was associated with improved survival from all-cause death over 5 years of follow-up.

Therapeutic management and one-year outcomes in elderly patients with acute coronary syndrome

“…Moreover, a systematic review of clinical studies performed to identify the health-related quality of life (HRQOL) after PCI in the elderly, showed that they have significant improvements in cardiovascular well-being after PCI [ 20 ]. Another recent study conducted in octogenarians, also exhibited the benefits of PCI in a cohort of 353 consecutive patients with ACS [ 21 ]. In overall cohort, 5-years all-cause mortality was 46.2% vs 89.5% comparing PCI and non-PCI groups, respectively.…”

“…In addition, a statistically significant association between PCI and reduced long-term mortality was found. Furthermore, a significant improved mean survival rates was observed for PCI-treated patients [ 21 ]. All these consistent data, together with the result of the Cox univariate and multivariate analysis performed in the present study, confirm that performing catheterization and revascularization have better outcomes than conservative medical therapy in elderly presenting ACS.…”

C<SUB>60</SUB> Fullerenes as a Novel Treatment for Poisoning and Envenomation: A Proof-of-Concept Study for Snakebite

“…We calculated phi ( as a measure of effect size, with values of ∼0.1, ∼0.3, and ≥0.5 roughly corresponding to small, medium, and large effects, respectively. 71 For experiment 2, we compared cricket mortality among the four C60 dosage groups using a Kaplan-Meier survival model, 75 which included both a dichotomous dependent variable (survival within 60 hr) and a continuous dependent variable (hours of survival, at the five time intervals). Because the two trials yielded identical conclusions, we combined them for analysis and presentation.…”

“…Because the two trials yielded identical conclusions, we combined them for analysis and presentation. We used the Mantel-Cox log-rank method 75 for multiple comparisons among C60 dosage groups. We calculated as an effect size for survival at 60 hr by comparing the proportion of crickets that survived in the 0 g/g control group …”

Expert Opinion Percutaneous Coronary Intervention in Older People: Does Age Make a Difference?

“…28 Most data come from large registry data sets. 29,30 In initial trials published including data from the Non-ST-Segment Elevation -ACS (NSTE-ACS) European registry, roughly a third (27-34 %) of patients are aged ≥75 years, but this proportion has dropped to no more than 20 % of all patients in recent trials. Even when older patients are recruited into clinical trials, they are highly selected, often having substantially less comorbidity than patients encountered in daily clinical practice.…”