Comparison of Outcomes After Percutaneous Coronary Intervention in Elderly Patients, Including 10 628 Nonagenarians: Insights From a Japanese Nationwide Registry (J‐PCI Registry)

Abstract

Background Scarce data exist about the outcomes after percutaneous coronary intervention ( PCI ) in old patients. This study sought to provide an overview of PCI in elderly patients, especially nonagenarians, in a Japanese large prospective nationwide registry. Methods and Results We analyzed 562 640 patients undergoing PCI (≥60 years of age) from 1018 Japanese hospitals between 2014 and 2016 in the J‐PCI (Japanese percutaneous coronary intervention) registry. Among them, 10 628 patients (1.9%), including 6780 (1.2%) with acute coronary syndrome ( ACS ) and 3848 (0.7%) with stable coronary artery disease, were ≥90 years of age. We investigated differences in characteristics and in‐hospital outcomes among sexagenarians, septuagenarians, octogenarians, and nonagenarians. Older patients were more frequently women and had a greater frequency of heart failure and chronic kidney disease than younger patients. In addition, older patients had a higher rate of in‐hospital mortality, cardiac tamponade, cardiogenic shock after PCI , and bleeding complications requiring blood transfusion. Nonagenarians had the highest risk of in‐hospital mortality (odds ratio, 3.60; 95% CI , 3.10–4.18 in ACS ; odds ratio , 6.24; 95% CI, 3.82–10.20 in non‐ ACS ) and bleeding complications ( odds ratio, 1.79; 95% CI, 1.35–2.36 in ACS ; odds ratio , 2.70; 95% CI, 1.68–4.35 in non‐ ACS ) when referenced to sexagenarians. More important, transradial intervention was an inverse independent predictor of both in‐hospital mortality and bleeding complications. Conclusions Older patients, especially nonagenarians, carried a greater risk of in‐hospital death and bleeding compared with younger patients after PCI . Transradial intervention might contribute to risk reduction for periprocedural complications in elderly patients undergoing PCI .

Comparison of In-Hospital Clinical Outcomes of Acute Myocardial Infarction Between Nonagenarians and Octogenarians

“…In earlier studies, Numasawa, et al investigated the clinical outcomes of elderly patients who underwent PCI and concluded that older patients, especially nonagenarians, carried a greater risk of in-hospital death. 10) Lee, et al reported that the in-hospital mortality was higher in nonagenarians than in octogenarians, 2) which is different from our results. The difference may be explained by the fact that only 57.2% of nonagenarians with AMI received PCI in their study.…”

“…7,9) Clinical evidences regarding AMI in nonagenarians are sparse. 10) It is unknown whether clinical outcomes after AMI in nonagenarians are comparable to those in octogenarians, while the number of nona-mary outcome for this study was in-hospital death, and the secondary outcome was the length of hospitalization. This study was approved by the institutional review board, and written informed consent was waived because of the retrospective study design.…”

Gender Differences in Clinical Outcomes of Patients with Coronary Artery Disease after Percutaneous Coronary Intervention

“…In a Japanese observational study including 43,231 patients with non-STsegment elevation acute coronary syndrome who underwent PCI from January 2014 to December 2014, the authors concluded that female patients had a higher risk of hospital complications than male patients, especially bleeding [5]. Another largescale cohort study involving 95,030 male and 35,955 female patients from a clinical registry of PCI procedures revealed that female gender remained as an independent predictor for mortality of patients with coronary artery disease underwent PCI after multivariable adjustment from January 2006 to February 2011 [6].…”

“…A prospective, multicenter, cohort study by Glaser et al has exhibited that female patients with non-ST-segment elevation acute coronary syndrome undergoing PCI at the age of 65 was more likely to have MACE than male patients with those at the same time [28]. Further analysis has shown that the incidence of congestive heart failure was higher in female patients with ST-segment elevation myocardial infarction than that in male patients with those, and the former was more likely to have cardiogenic shock when myocardial infarction occurred [5][6][7]. High incidence of ventricular septal rupture and severe mitral regurgitation during cardiogenic shock can be considered as important factors affecting the poor prognosis of female patients with myocardial infarction in the hospital.…”

“…In particular, previous studies have reported that the incidence of adverse outcomes in female patients with coronary artery disease after PCI is higher than that in male patients with those after PCI, including short-and long-term mortality, major adverse cardiovascular events (MACE), and revascularization. On the one hand, some studies have shown that gender differences in clinical outcomes persist after adjusting for multivariate factors, such as age, prior peripheral vascular disease, prior myocardial infarction, prior PCI, and chronic renal failure [5][6][7][8]. On the other hand, other studies have demonstrated that gender is not an independent factor in the clinical outcome [9][10][11].…”