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Tokuda K, Tanaka A, Uemura Y, Shibata N, Iwama M, Sakaguchi T, Yoshida R, Negishi Y, Tashiro H, Tanaka M, Tatami Y, Yamaguchi S, Yoshioka N, Umemoto N, Ohashi T, Takada Y, Asano H, Yoshida Y, Tanaka T, Noda T, Morishima I, Ishii H, Murohara T. Long-term clinical outcomes following percutaneous coronary intervention in patients aged 90 years and older. J Cardiol 2024:S0914-5087(24)00132-1. [PMID: 39034030 DOI: 10.1016/j.jjcc.2024.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 06/18/2024] [Accepted: 07/08/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND In an aging society, percutaneous coronary intervention (PCI) for super-elderly patients is commonly performed in clinical practice. However, data are scarce regarding the clinical features and outcomes of this population. METHODS This multicenter observational study enrolled patients aged over 90 years who underwent PCI across 10 hospitals between 2011 and 2020. The study included patients presenting with acute coronary syndrome (ACS) and chronic coronary syndrome (CCS). The occurrence of all-cause and cardiac deaths during hospitalization and after discharge was investigated. RESULTS In total, 402 patients (91.9 ± 2.0 years, 48.3 % male) participated in the study, of whom 77.9 % presented with ACS. The rate of in-hospital death was significantly higher in patients with ACS compared to patients with CCS (15.3 % vs. 2.2 %, p < 0.001). The estimated cumulative incidence rates of all-cause death were 24.3 %, 39.5 %, and 60.4 % at 1, 3, and 5 years, respectively. No significant difference was observed in the occurrence of all-cause death between patients with ACS and CCS. Regarding causes of death after discharge, non-cardiac deaths accounted for just over half of the cases. CONCLUSION This study highlights the clinical features and long-term clinical course of patients aged over 90 years who underwent PCI in a real-world setting. Patients presenting with ACS exhibited a higher rate of in-hospital mortality compared to those with CCS. Following discharge, both ACS and CCS patients experienced comparable and substantial increases in the incidence rates of both cardiac and non-cardiac mortality over time, and a more holistic management approach is warranted.
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Affiliation(s)
- Kotaro Tokuda
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akihito Tanaka
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Yusuke Uemura
- Cardiovascular Center, Anjo Kosei Hospital, Anjo, Japan
| | - Naoki Shibata
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Makoto Iwama
- Department of Cardiology, Gifu Prefectural General Medical Center, Gifu, Japan
| | | | - Ruka Yoshida
- Department of Cardiology, Japanese Red Cross Society Nagoya Daini Hospital, Nagoya, Japan
| | - Yosuke Negishi
- Department of Cardiology, Okazaki Municipal Hospital, Okazaki, Japan
| | - Hiroshi Tashiro
- Department of Cardiology, Ichinomiya Municipal Hospital, Ichinomiya, Japan
| | - Miho Tanaka
- Department of Cardiology, Konan Kosei Hospital, Konan, Japan
| | - Yosuke Tatami
- Department of Cardiology, Toyota Kosei Hospital, Toyota, Japan
| | | | - Naoki Yoshioka
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Norio Umemoto
- Department of Cardiology, Ichinomiya Municipal Hospital, Ichinomiya, Japan
| | - Taiki Ohashi
- Department of Cardiology, Toyota Kosei Hospital, Toyota, Japan
| | - Yasunobu Takada
- Department of Cardiology, Konan Kosei Hospital, Konan, Japan
| | - Hiroshi Asano
- Department of Cardiology, Tosei General Hospital, Seto, Japan
| | - Yukihiko Yoshida
- Department of Cardiology, Japanese Red Cross Society Nagoya Daini Hospital, Nagoya, Japan
| | - Toshikazu Tanaka
- Department of Cardiology, Okazaki Municipal Hospital, Okazaki, Japan
| | - Toshiyuki Noda
- Department of Cardiology, Gifu Prefectural General Medical Center, Gifu, Japan
| | - Itsuro Morishima
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Hideki Ishii
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Cardiology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Rahat O, Kheifets M, Bental T, Abigail Vons S, Tishler O, Lerman TT, Kaufman C, Perl L, Greenberg G, Codner P, Witberg G, Vaknin-Assa H, Kornowski R, Levi A. Is 90 the new 80? Temporal trends in nonagenarians undergoing percutaneous coronary interventions. Am J Med Sci 2024:S0002-9629(24)01330-2. [PMID: 38964467 DOI: 10.1016/j.amjms.2024.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 06/24/2024] [Accepted: 06/26/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND Coronary artery disease (CAD) is a leading cause of death in the elderly population. Data regarding percutaneous coronary interventions (PCIs) in nonagenarians are scarce, and differences in long term outcomes between generations remain unclear. We aimed to study the pattern and temporal trends of nonagenarians treated with PCI. MATERIALS AND METHODS A total of 14,695 patients underwent PCI between 2009-2020. We identified 2,034 (13.8%) octogenarians (age 80-89), and 222 (1.5%) nonagenarians (age 90-99). Endpoints included mortality and major adverse cardiac events (MACE) at 1 year. MATERIALS AND METHODS A total of 14,695 patients underwent PCI between 2009-2020. We identified 2,034 (13.8%) octogenarians (age 80-89), and 222 (1.5%) nonagenarians (age 90-99). Endpoints included mortality and major adverse cardiac events (MACE) at 1 year. RESULTS The number of nonagenarians undergoing PCI has increased substantially during the study time period, from 89 patients in the earlier time period (2009-2014) to 133 patients in the later time period (2015-2020). At 1-year, nonagenarians had significantly higher rates of both death (24.3% vs. 14.9%, p<0.01), and MACE (30.6% vs. 22.0%, p<0.01), as compared to octogenarians. The cumulative survival rate was higher among octogenarians both in the early and late time period (p<0.01 and p=0.039, respectively). A significant reduction in nonagenarian MACE rates were observed during the study time period, resulting in a non-significant difference in MACE rates in the later time period between both groups. CONCLUSION The number of nonagenarians who undergo PCI is on the rise. While their clinical outcomes are inferior as compared to younger age groups, improvement was noted in the late time period.
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Affiliation(s)
- Ori Rahat
- Department of Cardiology, Rabin Medical Center, Petach Tikva; affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Mark Kheifets
- Department of Cardiology, Rabin Medical Center, Petach Tikva; affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tamir Bental
- Department of Cardiology, Rabin Medical Center, Petach Tikva; affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shelly Abigail Vons
- Department of Cardiology, Rabin Medical Center, Petach Tikva; affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ori Tishler
- Internal Department F, Rabin Medical Center, Petach Tikva; affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tsahi T Lerman
- Department of Cardiology, Rabin Medical Center, Petach Tikva; affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Internal Department F, Rabin Medical Center, Petach Tikva; affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Leor Perl
- Department of Cardiology, Rabin Medical Center, Petach Tikva; affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gabriel Greenberg
- Department of Cardiology, Rabin Medical Center, Petach Tikva; affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Pablo Codner
- Department of Cardiology, Rabin Medical Center, Petach Tikva; affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Guy Witberg
- Department of Cardiology, Rabin Medical Center, Petach Tikva; affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hana Vaknin-Assa
- Department of Cardiology, Rabin Medical Center, Petach Tikva; affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, Petach Tikva; affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amos Levi
- Department of Cardiology, Rabin Medical Center, Petach Tikva; affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Park DY, Hanna JM, Kadian S, Kadian M, Jones WS, Damluji AA, Kochar A, Curtis JP, Nanna MG. In-hospital outcomes and readmission in older adults treated with percutaneous coronary intervention for stable ischemic heart disease. J Geriatr Cardiol 2022; 19:631-642. [PMID: 36284680 PMCID: PMC9548058 DOI: 10.11909/j.issn.1671-5411.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Background Percutaneous coronary intervention (PCI) for stable ischemic heart disease (SIHD) in older adults requires a meticulous assessment of procedural risks and benefits, but contemporary data on outcomes in this population is lacking. Therefore, we examined the risk of near-term readmission, bleeding, and mortality in high-risk cohort of older adults undergoing inpatient PCI for SIHD. METHODS We analyzed the National Readmissions Database from 2017 to 2018 to identify index hospitalizations in which PCI was performed for SIHD. Patients were stratified into those ≥ 75 years old (older adults) and those < 75 years old. The primary outcome was 90-day readmission. Secondary outcomes included in-hospital mortality, hospital length of stay (LOS), and total hospital charge. RESULTS A total of 74,516 patients underwent inpatient PCI for SIHD, of whom 24,075 were older adults. Older adult patients had higher odds of in-hospital mortality (OR = 2.00, 95% CI: 1.68-2.38), intracranial hemorrhage (OR = 2.03, 95% CI: 1.24-3.34), and gastrointestinal hemorrhage (OR = 1.72, 95% CI: 1.43-2.07) during index hospitalization, with longer LOS and in-hospital charge. Older adults also experienced a higher hazard of 90-day readmission for any cause (HR = 1.61, 95% CI: 1.57-1.66) and cardiovascular causes (HR = 1.84, 95% CI: 1.77-1.91). CONCLUSION Older adults undergoing inpatient PCI for SIHD were at increased risk for in-hospital mortality, periprocedural morbidities, higher cost, and readmissions compared with younger adults. Understanding these differences may improve shared decision-making for patients with SIHD being considered for PCI.
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Affiliation(s)
- Dae Yong Park
- Department of Medicine, Cook County Health, Chicago, IL, USA
| | - Jonathan M. Hanna
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | | | | | - W. Schuyler Jones
- Section of Interventional Cardiology, Duke University Health System, Durham, NC, USA
| | - Abdulla Al Damluji
- Section of Interventional Cardiology, Johns Hopkins University, Baltimore, MD, USA
| | - Ajar Kochar
- Section of Interventional Cardiology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Jeptha P. Curtis
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Michael G. Nanna
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
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Perl L, Franzé A, D’Ascenzo F, Golomb N, Levi A, Vaknin-Assa H, Greenberg G, Assali A, De Ferrari GM, Kornowski R. Elderly Suffering from ST-Segment Elevation Myocardial Infarction-Results from a Database Analysis from Two Mediterranean Medical Centers. J Clin Med 2021; 10:jcm10112435. [PMID: 34070865 PMCID: PMC8199382 DOI: 10.3390/jcm10112435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 05/12/2021] [Accepted: 05/27/2021] [Indexed: 01/06/2023] Open
Abstract
Background: Little is known regarding primary percutaneous coronary intervention (pPCI) for ST-segment elevation myocardial infarction (STEMI) in the elderly. Methods: Data on 319 octogenarians, 641 septuagenarians, and 2451 younger patients was collected from an ongoing prospective registry of patients treated with pPCI for STEMI at two Mediterranean-area medical centers in 2009–2017. Results: More octogenarian patients were female (40.8 vs. 31.9 septuagenarians and 26.5% under 70 y, p < 0.01), had hypertension (79.5 vs. 69.5 and 45.9%, p < 0.01), renal failure (32.5 vs. 20.1 and 5.2%, p < 0.01), and a lower left-ventricular ejection fraction (42.0 vs. 44.9 and 47.6%, p = 0.012). At 1 month and 3 years after intervention, mortality was higher in the octogenarian patients (12.2 vs. 7.9%, p = 0.01; and 36.7 vs. 23.1%, p < 0.01, respectively), with no significant differences in the rates of recurrent myocardial infarction, target vessel revascularization, coronary artery bypass surgery, and cardiovascular death. Following adjustment for confounders, 3-year mortality was significantly higher in the octogenarians (HR 3.89 vs. 3.19 for septuagenarians, p < 0.01), but rates of major adverse cardiac events or cardiovascular death were not. Conclusions: Despite suffering from higher all-cause mortality, octogenarian patients treated with pPCI for STEMI do not suffer an increased risk of ischemic cardiac events relative to younger patients.
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Affiliation(s)
- Leor Perl
- Department of Cardiology, Rabin Medical Center—Beilinson Hospital, Petach Tikva 4941492, Israel; (N.G.); (A.L.); (H.V.-A.); (G.G.); (R.K.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel;
- Correspondence: or ; Tel.: +972-3-9372251; Fax: +972-3-9372460
| | - Alfonso Franzé
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Corso Bramante 88, 10126 Turin, Italy; (A.F.); (F.D.)
| | - Fabrizio D’Ascenzo
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Corso Bramante 88, 10126 Turin, Italy; (A.F.); (F.D.)
| | - Noa Golomb
- Department of Cardiology, Rabin Medical Center—Beilinson Hospital, Petach Tikva 4941492, Israel; (N.G.); (A.L.); (H.V.-A.); (G.G.); (R.K.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel;
| | - Amos Levi
- Department of Cardiology, Rabin Medical Center—Beilinson Hospital, Petach Tikva 4941492, Israel; (N.G.); (A.L.); (H.V.-A.); (G.G.); (R.K.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel;
| | - Hana Vaknin-Assa
- Department of Cardiology, Rabin Medical Center—Beilinson Hospital, Petach Tikva 4941492, Israel; (N.G.); (A.L.); (H.V.-A.); (G.G.); (R.K.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel;
| | - Gabriel Greenberg
- Department of Cardiology, Rabin Medical Center—Beilinson Hospital, Petach Tikva 4941492, Israel; (N.G.); (A.L.); (H.V.-A.); (G.G.); (R.K.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel;
| | - Abid Assali
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel;
- Department of Cardiology, Meir Medical Center, Tchernichovsky St 59, Kfar-Saba 4428164, Israel
| | - Gaetano M. De Ferrari
- Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Viale Camillo Golgi 19, 27100 Pavia, Italy;
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center—Beilinson Hospital, Petach Tikva 4941492, Israel; (N.G.); (A.L.); (H.V.-A.); (G.G.); (R.K.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel;
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Managing Nonagenarians with Acute Myocardial Infarction: Invasive versus Conservative Treatment. Cardiol Res Pract 2020; 2020:8885518. [PMID: 33224527 PMCID: PMC7671813 DOI: 10.1155/2020/8885518] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/08/2020] [Accepted: 10/30/2020] [Indexed: 12/27/2022] Open
Abstract
Background Limited data are available to support an invasive treatment strategy in nonagenarians with acute myocardial infarction (AMI). We aimed to investigate whether percutaneous coronary intervention (PCI) is beneficial in this frail population. Methods We retrospectively analyzed 41 nonagenarians with AMI (both ST-segment-elevation and non-ST-segment-elevation MI) between 2006 and 2015 in a single center. We assessed 30-day and one-year mortality rates according to the treatment strategy. Results Among study subjects, 24 (59%) were treated with PCI (PCI group) and 17 (41%) were treated with conservative management (medical treatment group) per the clinician's discretion. The median follow-up duration was 30 months (0–74 months). Thirty-day mortality was lower in the PCI group than in the medical treatment group (17% vs. 65%; P < 0.001). One-year mortality was also lower in the PCI group than in the medical treatment group (21% vs. 76%; P < 0.001). The PCI group presented a 73% decreased risk of death (adjusted hazard ratio: 0.269; 95% confidence interval: 0.126–0.571; P < 0.001). In the Killip class 1 through 3 subgroups (n = 36), 30-day and one-year mortality were still higher among those in the medical treatment group (13% vs. 54% at 30 days; P < 0.001 and 17% vs. 69% at one year; P < 0.001). Landmark analysis after 30 days revealed no significant difference in the cumulative mortality rate between the two groups, indicating that the mortality difference was mainly determined within the first 30 days after AMI. Conclusion Mortality after AMI was decreased in correlation with the invasive strategy relative to the conservative strategy, even in nonagenarians. Regardless of age, PCI should be considered in AMI patients. However, large-scale randomized controlled trials are needed to support our conclusion.
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Raoul F, Sanchez S, Dacunka M, Nazeyrollas P, Al Amoura A, Girodet B, Mailler B, Chapoutot L, Marchais A. [Complications of coronary invasive procedures in nonagenarians: A case-control study]. Ann Cardiol Angeiol (Paris) 2020; 69:219-226. [PMID: 32800321 DOI: 10.1016/j.ancard.2020.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 07/21/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Coronary heart disease is the leading cause of morbidity and mortality in nonagenarians, whose numbers have doubled in twenty years. In the absence of recommendations, the place of coronary invasive strategy in this population remains a therapeutic challenge and its interest as well as its risks are poorly established. The aim of our study was to evaluate the safety of coronary invasive practice in the nonagenarian population for all indications. POPULATION AND METHODS This was a monocentric case-control study conducted from January 1, 2010 to May 30, 2019. The patients included were all nonagenarians who had undergone coronary angiography at the centre hospitalier de Troyes during this period. For each patient included, two controls matched on sex, date of procedure and procedure were drawn at random. The main judgment criterion was the occurrence of immediate per- or post-procedure complications during the stay in which the procedure was performed. The main secondary outcome measures were average length of stay, occurrence of intercurrent events during the stay (nosocomial infections, confusional syndrome), and loss of autonomy. RESULTS In all, 59 nonagenarians and 118 controls were included in our study. We identified 30.5% major complications in the nonagenarians versus 10.2% in the controls (P=0.001; OR=0.26 [0.1-0.6]), with a significant difference in the occurrence of cardiogenic shock (P=0.04), heart failure (P=0.02) and ventricular rhythm disorders (P=0.04). Post-procedure acute renal failure was greater in the nonagenarians (P=0.02; OR=0.20 [0.05-1.57]). The mean length of stay was on average twice as long in the nonagenarians. CONCLUSION Nonagenarian patients are subject to more complications when undergoing coronary invasive procedures compared to patients under 75.
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Affiliation(s)
- F Raoul
- Pôle vasculaire, service de cardiologie, centre hospitalier de Troyes, 101, avenue Anatole-France, 10000 Troyes, France.
| | - S Sanchez
- Pôle territorial santé publique et performance, centre hospitalier de Troyes, 101, avenue Anatole-France, 10000 Troyes, France.
| | - M Dacunka
- Pôle vasculaire, service de cardiologie, centre hospitalier de Troyes, 101, avenue Anatole-France, 10000 Troyes, France.
| | - P Nazeyrollas
- Pôle vasculaire, service de cardiologie, centre hospitalo-universitaire de Reims, 52, avenue Cognacq-Jay, 51100 Reims, France.
| | - A Al Amoura
- Pôle vasculaire, service de cardiologie, centre hospitalier de Troyes, 101, avenue Anatole-France, 10000 Troyes, France.
| | - B Girodet
- Pôle vasculaire, service de cardiologie, centre hospitalier de Troyes, 101, avenue Anatole-France, 10000 Troyes, France.
| | - B Mailler
- Pôle vasculaire, service de cardiologie, centre hospitalier de Troyes, 101, avenue Anatole-France, 10000 Troyes, France.
| | - L Chapoutot
- Pôle vasculaire, service de cardiologie, centre hospitalier de Troyes, 101, avenue Anatole-France, 10000 Troyes, France.
| | - A Marchais
- Pôle vasculaire, service de cardiologie, centre hospitalier de Troyes, 101, avenue Anatole-France, 10000 Troyes, France.
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Numasawa Y, Inohara T, Ishii H, Yamaji K, Kohsaka S, Sawano M, Kodaira M, Uemura S, Kadota K, Amano T, Nakamura M. Comparison of Outcomes After Percutaneous Coronary Intervention in Elderly Patients, Including 10 628 Nonagenarians: Insights From a Japanese Nationwide Registry (J-PCI Registry). J Am Heart Assoc 2019; 8:e011183. [PMID: 30791799 PMCID: PMC6474917 DOI: 10.1161/jaha.118.011017] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 01/15/2019] [Indexed: 12/22/2022]
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 .
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Affiliation(s)
- Yohei Numasawa
- Department of CardiologyJapanese Red Cross Ashikaga HospitalAshikagaJapan
| | - Taku Inohara
- Duke Clinical Research InstituteDuke University Medical CenterDurhamNC
- Department of CardiologyKeio University School of MedicineTokyoJapan
| | - Hideki Ishii
- Department of CardiologyNagoya University Graduate School of MedicineNagoyaJapan
| | - Kyohei Yamaji
- Department of CardiologyKokura Memorial HospitalKitakyushuJapan
| | - Shun Kohsaka
- Department of CardiologyKeio University School of MedicineTokyoJapan
| | - Mitsuaki Sawano
- Department of CardiologyKeio University School of MedicineTokyoJapan
| | - Masaki Kodaira
- Department of CardiologyJapanese Red Cross Ashikaga HospitalAshikagaJapan
| | - Shiro Uemura
- Department of CardiologyKawasaki Medical SchoolKurashikiJapan
| | - Kazushige Kadota
- Department of CardiologyKurashiki Central HospitalKurashikiJapan
| | - Tetsuya Amano
- Department of CardiologyAichi Medical UniversityNagakuteJapan
| | - Masato Nakamura
- Division of Cardiovascular MedicineToho University Ohashi Medical CenterTokyoJapan
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Rasania SP, Chamaria S, Vengrenyuk Y, Baber U, Dangas G, Mehran R, Barman N, Sweeny J, Kini A, Sharma S. Percutaneous Coronary Intervention Outcomes in Very Elderly Patients From a Single Large-Volume Tertiary Care Center, Specifically Focusing on Nonagenarians. JACC Cardiovasc Interv 2017. [DOI: 10.1016/j.jcin.2017.03.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Mizuguchi Y, Hashimoto S, Shibutani H, Yamada T, Taniguchi N, Nakajima S, Hata T, Takahashi A. Successful treatment of a nonagenarian patient with acute coronary syndrome complicated with chronic total occlusion of the left main coronary artery. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2016; 18:276-280. [PMID: 27838181 DOI: 10.1016/j.carrev.2016.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 10/08/2016] [Accepted: 10/14/2016] [Indexed: 10/20/2022]
Abstract
Although chronic total occlusion of the left main coronary artery (LMCA) is considered very rare, this condition could be fatal if it becomes complicated with an acute coronary syndrome lesion in the right coronary artery (RCA) which is usually the only remaining coronary artery for the myocardium. We reported a successfully treated case of a nonagenarian patient with ST-segment elevation myocardial infarction, who had subtotal occlusion of the RCA and total occlusion of the LMCA with Rentrop grade 2 collateral coronary artery supply from the RCA.
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Affiliation(s)
- Yukio Mizuguchi
- Cardiovascular Section, Sakurakai Takahashi Hospital, 5-18-1 Oikecho, Suma-ku, Kobe, Hyogo 654-0026, Japan.
| | - Sho Hashimoto
- Cardiovascular Section, Sakurakai Takahashi Hospital, 5-18-1 Oikecho, Suma-ku, Kobe, Hyogo 654-0026, Japan
| | - Hiroki Shibutani
- Cardiovascular Section, Sakurakai Takahashi Hospital, 5-18-1 Oikecho, Suma-ku, Kobe, Hyogo 654-0026, Japan
| | - Takeshi Yamada
- Cardiovascular Section, Sakurakai Takahashi Hospital, 5-18-1 Oikecho, Suma-ku, Kobe, Hyogo 654-0026, Japan
| | - Norimasa Taniguchi
- Cardiovascular Section, Sakurakai Takahashi Hospital, 5-18-1 Oikecho, Suma-ku, Kobe, Hyogo 654-0026, Japan
| | - Shunsuke Nakajima
- Cardiovascular Section, Sakurakai Takahashi Hospital, 5-18-1 Oikecho, Suma-ku, Kobe, Hyogo 654-0026, Japan
| | - Tetsuya Hata
- Cardiovascular Section, Sakurakai Takahashi Hospital, 5-18-1 Oikecho, Suma-ku, Kobe, Hyogo 654-0026, Japan
| | - Akihiko Takahashi
- Cardiovascular Section, Sakurakai Takahashi Hospital, 5-18-1 Oikecho, Suma-ku, Kobe, Hyogo 654-0026, Japan
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Peiyuan H, Jingang Y, Haiyan X, Xiaojin G, Ying X, Yuan W, Wei L, Yang W, Xinran T, Ruohua Y, Chen J, Lei S, Xuan Z, Rui F, Yunqing Y, Qiuting D, Hui S, Xinxin Y, Runlin G, Yuejin Y. The Comparison of the Outcomes between Primary PCI, Fibrinolysis, and No Reperfusion in Patients ≥ 75 Years Old with ST-Segment Elevation Myocardial Infarction: Results from the Chinese Acute Myocardial Infarction (CAMI) Registry. PLoS One 2016; 11:e0165672. [PMID: 27812152 PMCID: PMC5094717 DOI: 10.1371/journal.pone.0165672] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 10/14/2016] [Indexed: 12/22/2022] Open
Abstract
Background Only a few randomized trials have analyzed the clinical outcomes of elderly ST-segment elevation myocardial infarction (STEMI) patients (≥ 75 years old). Therefore, the best reperfusion strategy has not been well established. An observational study focused on clinical outcomes was performed in this population. Methods Based on the national registry on STEMI patients, the in-hospital outcomes of elderly patients with different reperfusion strategies were compared. The primary endpoint was defined as death. Secondary endpoints included recurrent myocardial infarction, ischemia driven revascularization, myocardial infarction related complications, and major bleeding. Multivariable regression analysis was performed to adjust for the baseline disparities between the groups. Results Patients who had primary percutaneous coronary intervention (PCI) or fibrinolysis were relatively younger. They came to hospital earlier, and had lower risk of death compared with patients who had no reperfusion. The guideline recommended medications were more frequently used in patients with primary PCI during the hospitalization and at discharge. The rates of death were 7.7%, 15.0%, and 19.9% respectively, with primary PCI, fibrinolysis, and no reperfusion (P < 0.001). Patients having primary PCI also had lower rates of heart failure, mechanical complications, and cardiac arrest compared with fibrinolysis and no reperfusion (P < 0.05). The rates of hemorrhage stroke (0.3%, 0.6%, and 0.1%) and other major bleeding (3.0%, 5.0%, and 3.1%) were similar in the primary PCI, fibrinolysis, and no reperfusion group (P > 0.05). In the multivariable regression analysis, primary PCI outweighs no reperfusion in predicting the in-hospital death in patients ≥ 75 years old. However, fibrinolysis does not. Conclusions Early reperfusion, especially primary PCI was safe and effective with absolute reduction of mortality compared with no reperfusion. However, certain randomized trials were encouraged to support the conclusion.
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Affiliation(s)
- He Peiyuan
- Department of Cardiology, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Yang Jingang
- Department of Cardiology, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Xu Haiyan
- Department of Cardiology, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Gao Xiaojin
- Department of Cardiology, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Xian Ying
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, United States of America
| | - Wu Yuan
- Department of Cardiology, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Li Wei
- Medical Research & Biometrics Center, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Wang Yang
- Medical Research & Biometrics Center, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Tang Xinran
- Medical Research & Biometrics Center, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Yan Ruohua
- Medical Research & Biometrics Center, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Jin Chen
- Medical Research & Biometrics Center, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Song Lei
- Department of Cardiology, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Zhang Xuan
- Department of Cardiology, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Fu Rui
- Department of Cardiology, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Ye Yunqing
- Department of Cardiology, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Dong Qiuting
- Department of Cardiology, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Sun Hui
- Department of Cardiology, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Yan Xinxin
- Department of Cardiology, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Gao Runlin
- Department of Cardiology, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Yang Yuejin
- Department of Cardiology, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
- * E-mail:
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Outcomes of percutaneous coronary intervention in patients ≥ 75 years: one-center study in a Chinese patient group. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2016; 12:626-33. [PMID: 26788039 PMCID: PMC4712368 DOI: 10.11909/j.issn.1671-5411.2015.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Objective To investigate the clinical and perioperative characteristics of patients ≥ 75 who undergoing percutaneous coronary intervention (PCI) and to evaluate the risk factors related to short-term post-PCI mortality in this specific patients group. Methods 1,035 consecutive subjects who underwent PCI from December 2011 to November 2013 were divided into four categories: (1) patients with stable angina (SA) ≥ 75 years (n = 58); (2) patients with SA < 75 years (n = 218); (3) patients with acute coronary syndrome (ACS) ≥ 75 years (n = 155); (4) patients with ACS < 75 years (n = 604). A multivariable logistic regression analysis was conducted to detect risk factors of six-month mortality in patients ≥ 75 years who had undergone PCI. Clinical comorbidities, in-hospital biochemical indicators, perioperative data, in-hospital and six-month outcomes were analyzed and compared among the four groups. Results Compared with the younger group, patients ≥ 75 years were more likely to have hypertension, history of stroke, chronic obstructive pulmonary disease, peripheral vascular disease, cardiogenic shock and malignant arrhythmia, and they were admitted to hospital with relative lower weight, hemoglobin, albumin, triglyceride, higher creatinine, uric acid, urea nitrogen and pro-BNP. Left main artery lesions, multi-vessel, calcified lesions, chronic totally occlusion were also more likely to be seen in the elderly group. Univariate analysis revealed that age ≥ 85 years, cardiogenic shock or severe arrhythmia at admission, emergency PCI, prior stroke and chronic kidney disease were related to six-month mortality in elderly patients ≥ 75 years who underwent PCI. Multivariable logistic regression showed that cardiogenic shock or severe arrhythmia at admission, chronic kidney disease and prior stroke were independent risk factors predicting six-month mortality in elderly patients ≥ 75 years who had undergone PCI. Conclusions Our data showed that, compared with patients under 75 years, elderly patients (≥ 75 years) who had undergone PCI had a relative higher risk of mortality, and more often accompanied with multi-comorbidities, severer admission conditions and complex coronary lesions. Better evaluation of risk factors and more intensively care should be taken to patients ≥ 75 years who had undergone PCI therapy to reduce complications.
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Mizuguchi Y, Hashimoto S, Yamada T, Taniguchi N, Nakajima S, Hata T, Takahashi A. Percutaneous coronary intervention for nonagenarian patients with ST-segment elevation myocardial infarction: Experience of a single Japanese center. J Cardiol 2016; 67:331-4. [PMID: 26775888 DOI: 10.1016/j.jjcc.2015.12.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 11/11/2015] [Accepted: 12/01/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND Old age is a prognostic risk factor for patients with ST elevation acute myocardial infarction (STEMI); however, few data exist describing STEMI patients aged over 90 years. METHODS We retrospectively evaluated the clinical indices and outcomes of 282 consecutive STEMI patients who underwent primary percutaneous coronary intervention (PCI) in our hospital between January 2008 and December 2012. Patients with acute myocardial infarction complicated by out-of-hospital cardiopulmonary arrest, patients with a left main trunk culprit lesion, and patients diagnosed more than 24h after symptom onset were excluded. RESULTS Of the patients treated during the study period, 11 (3.8%) were >90 years old. The mean door-to-balloon time was significantly longer for nonagenarians than younger patients (66.2 vs. 44.0minutes; p<0.001). This was mainly attributed to delays in decision-making regarding invasive treatment by both the doctors and families. Nonagenarians had multiple coronary artery stenoses more frequently (36.4% vs. 15.0%; p<0.05) and required intra-aortic balloon pumping more often (36.4% vs. 18.9%; p=0.15) compared with patients aged ≤89 years. However, the peak creatinine kinase levels and the left ventricular ejection fractions were similar between the groups. Moreover, the in-hospital and 30-day mortality rates were similar (9.1% vs. 4.6%, p=0.50; 9.1% vs. 3.6%, p=0.34, respectively) between the groups. The two-year survival rate was 81.8% in nonagenarians. CONCLUSIONS Despite the longer door-to-balloon time, higher use of intra-aortic balloon pumping, and larger number of diseased vessels, the 30-day and 2-year survival rates of nonagenarians with STEMI were comparable to those of younger patients.
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Affiliation(s)
- Yukio Mizuguchi
- Cardiovascular Section, Sakurakai Takahashi Hospital, Hyogo, Japan.
| | - Sho Hashimoto
- Cardiovascular Section, Sakurakai Takahashi Hospital, Hyogo, Japan
| | - Takeshi Yamada
- Cardiovascular Section, Sakurakai Takahashi Hospital, Hyogo, Japan
| | | | | | - Tetsuya Hata
- Cardiovascular Section, Sakurakai Takahashi Hospital, Hyogo, Japan
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Potluri R, Reynolds J, Carter P, Baig M, Aziz A, Potluri S, Ali N, Uppal H, Chandran S. The role of angioplasty in octogenarian patients with Acute Coronary Syndrome. Int J Cardiol 2016; 202:430-2. [DOI: 10.1016/j.ijcard.2015.09.080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 09/21/2015] [Indexed: 12/16/2022]
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14
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Lee KH, Ahn Y, Kim SS, Rhew SH, Jeong YW, Jang SY, Cho JY, Jeong HC, Park KH, Yoon NS, Sim DS, Yoon HJ, Kim KH, Hong YJ, Park HW, Kim JH, Cho JG, Park JC, Jeong MH, Cho MC, Kim CJ, Kim YJ. Characteristics, in-hospital and long-term clinical outcomes of nonagenarian compared with octogenarian acute myocardial infarction patients. J Korean Med Sci 2014; 29:527-35. [PMID: 24753700 PMCID: PMC3991796 DOI: 10.3346/jkms.2014.29.4.527] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 02/10/2014] [Indexed: 11/20/2022] Open
Abstract
We compared clinical characteristics, management, and clinical outcomes of nonagenarian acute myocardial infarction (AMI) patients (n=270, 92.3 ± 2.3 yr old) with octogenarian AMI patients (n=2,145, 83.5 ± 2.7 yr old) enrolled in Korean AMI Registry (KAMIR). Nonagenarians were less likely to have hypertension, diabetes and less likely to be prescribed with beta-blockers, statins, and glycoprotein IIb/IIIa inhibitors compared with octogenarians. Although percutaneous coronary intervention (PCI) was preferred in octogenarians than nonagenarians, the success rate of PCI between the two groups was comparable. In-hospital mortality, the composite of in-hospital adverse outcomes and one year mortality were higher in nonagenarians than in octogenarians. However, the composite of the one year major adverse cardiac events (MACEs) was comparable between the two groups without differences in MI or re-PCI rate. PCI improved 1-yr mortality (adjusted hazard ratio [HR], 0.50; 95% confidence interval [CI], 0.36-0.69, P<0.001) and MACEs (adjusted HR, 0.47; 95% CI, 0.37-0.61, P<0.001) without significant complications both in nonagenarians and octogenarians. In conclusion, nonagenarians had similar 1-yr MACEs rates despite of higher in-hospital and 1-yr mortality compared with octogenarian AMI patients. PCI in nonagenarian AMI patients was associated to better 1-yr clinical outcomes.
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Affiliation(s)
- Ki Hong Lee
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Youngkeun Ahn
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Sung Soo Kim
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Si Hyun Rhew
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Young Wook Jeong
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Soo Young Jang
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Jae Yeong Cho
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Hae Chang Jeong
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Keun-Ho Park
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Nam Sik Yoon
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Doo Sun Sim
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Hyun Joo Yoon
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Kye Hun Kim
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Young Joon Hong
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Hyung Wook Park
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Ju Han Kim
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Jeong Gwan Cho
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Jong Chun Park
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Myung Ho Jeong
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Myeong-Chan Cho
- Department of Internal Medicine, College of Medicine, Chungbuk National University, Chungju, Korea
| | - Chong Jin Kim
- Department of Cardiovascular Medicine, East West Neo Medical Center, Seoul, Korea
| | - Young Jo Kim
- Department of Cardiovascular Medicine, Yeungnam University Hospital, Daegu, Korea
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Presutti DG, D’Ascenzo F, Omedè P, Biondi-Zoccai G, Moretti C, Bollati M, Sciuto F, Lee MS, Moreno R, Bikkina M, Di Cuia M, Resmini C, Gaita F, Sheiban I. Percutaneous coronary intervention in nonagenarian. J Cardiovasc Med (Hagerstown) 2013; 14:773-9. [PMID: 23756410 DOI: 10.2459/jcm.0b013e3283619410] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Sillano D, Resmini C, Meliga E, Boccuzzi G, Zuffi A, Barbato E, Gunn J, Price M, Gaita F, Sheiban I. Retrospective multicenter observational study of the interventional management of coronary disease in the very elderly: The NINETY. Catheter Cardiovasc Interv 2013; 82:414-21. [DOI: 10.1002/ccd.24406] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Revised: 02/29/2012] [Accepted: 03/03/2012] [Indexed: 11/05/2022]
Affiliation(s)
- Dario Sillano
- Division of Interventional Cardiology; University of Turin; Turin; Italy
| | - Chiara Resmini
- Division of Interventional Cardiology; University of Turin; Turin; Italy
| | | | | | - Andrea Zuffi
- Division of Cardiology; Villa Maria Cecilia Hospital; Cotignola; Ravenna; Italy
| | - Emanuele Barbato
- Division of Cardiology; Cardiovascular Center Onze Lieve Vrouw Ziekenhouis; Aalst; Belgium
| | - Julian Gunn
- Division of Cardiology; University of Sheffield; Sheffield; United Kingdom
| | - Matthew Price
- Division of Cardiology; Scripps Clinic; La Jolla; California
| | - Fiorenzo Gaita
- Division of Interventional Cardiology; University of Turin; Turin; Italy
| | - Imad Sheiban
- Division of Interventional Cardiology; University of Turin; Turin; Italy
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Biondi Zoccai G, Abbate A, D'Ascenzo F, Presutti D, Peruzzi M, Cavarretta E, Marullo AGM, Lotrionte M, Frati G. Percutaneous coronary intervention in nonagenarians: pros and cons. J Geriatr Cardiol 2013; 10:82-90. [PMID: 23610578 PMCID: PMC3627716 DOI: 10.3969/j.issn.1671-5411.2013.01.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Revised: 01/15/2013] [Accepted: 02/28/2013] [Indexed: 02/05/2023] Open
Abstract
Percutaneous coronary intervention is a mainstay in the management of symptomatic or high-risk coronary artery disease. The bulk of clinical evidence and experience underlying this fact relies, however, on relatively young patients. Indeed, few data of very limited quality are available which adequately define the risk-benefit and cost-benefit profile of coronary angioplasty and stenting in very old subjects, such as those of 90 years of age or older (i.e., nonagenarians). The aim of this review is to provide a concise, yet practical, synthesis of the available evidence on percutaneous coronary revascularization in the very elderly. The main arguments elaborated upon are to what extent we can extrapolate findings from studies including younger patients to nonagenarians, whether we should provide higher priority to prognosis or quality of life in such patients, and whether we can afford to allocate vast resources to care for such subjects in an era of financial constraints. Our review of 18 studies and 1082 patients suggest that percutaneous coronary intervention is feasible and associated with acceptable short- and long-term results in this population, which is nonetheless fraught with a high mortality risk irrespective of the revascularization procedure. Accordingly, the pros and cons of percutaneous coronary intervention should be carefully weighed when considering this treatment in nonagenarians.
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Affiliation(s)
- Giuseppe Biondi Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 79, 04100 Latina, Italy
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Safety, effectiveness, and outcomes of cardiac catheterization in nonagenarians. Am J Cardiol 2012; 110:1231-3. [PMID: 22858188 DOI: 10.1016/j.amjcard.2012.06.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 06/20/2012] [Accepted: 06/20/2012] [Indexed: 11/21/2022]
Abstract
With an aging population, nonagenarians (≥90 years of age) are increasingly being considered for cardiac catheterization. Because of the paucity of outcomes data in this population, we sought to evaluate the acute and intermediate outcomes of nonagenarians undergoing cardiac catheterization. A retrospective cohort of 44 nonagenarians undergoing 53 cardiac catheterizations from 2002 to 2010 was identified. Mean age was 91 years (range 90 to 96) with 57% of patients being women. Thirteen percent presented with ST-segment elevation myocardial infarction, 32% with non-ST-segment elevation myocardial infarction, 14% with unstable angina, 25% with chronic angina, and 16% with aortic stenosis. Eighteen percent had left main coronary artery disease and 73% had multivessel coronary disease. Complications occurred in 6 of 44 patients (3 with acute kidney injury, 2 with atrial fibrillation, 1 with femoral artery pseudoaneurysm). Twenty patients were treated with medical management, 1 patient underwent coronary artery bypass surgery, and 2 patients underwent aortic valve replacement. Twenty-one patients underwent percutaneous coronary intervention in 27 different vessels. There was procedural success in 93% of these patients. There were no major adverse cardiac events. Five complications occurred after the intervention (4 atrial fibrillations, 1 femoral artery pseudoaneurysm). Cumulative mortalities at 1 month and 6 and 12 months were 0%, 9%, and 20% respectively. In patients who underwent percutaneous coronary intervention or surgery, mortalities were 0%, 0%, and 13% at 1 month and 6 and 12 months, respectively.
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Percutaneous Coronary Intervention in Very Elderly Patients. In-hospital Mortality and Clinical Outcome. Heart Lung Circ 2011; 20:622-8. [DOI: 10.1016/j.hlc.2010.08.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Thomas MP, Moscucci M, Smith DE, Aronow H, Share D, Kraft P, Gurm HS. Outcome of contemporary percutaneous coronary intervention in the elderly and the very elderly: insights from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium. Clin Cardiol 2011; 34:549-54. [PMID: 21717474 DOI: 10.1002/clc.20926] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Revised: 05/09/2011] [Accepted: 05/09/2011] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND There is a paucity of data on the outcome of contemporary percutaneous coronary intervention (PCI) in the elderly. Accordingly, we assessed the impact of age on outcome of a large cohort of patients undergoing PCI in a regional collaborative registry. HYPOTHESIS Increasing age is associated with a higher incidence of procedural-related complications. METHODS We evaluated the outcome of 152,373 patients who underwent PCI from 2003 to 2008 in the 31 hospitals participating in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium. The procedural outcomes of the cohort were compared by dividing patients into < 70 years of age, 70 to 79 years, 80 to 84 years, 85 to 89 years, and ≥ 90 years. RESULTS Of the cohort, 64.64% were <70 years of age, 23.83% were 70 to 79 years, 7.85% were 80 to 84 years, 3.09% were 85 to 89 years, and 0.58% were 90 years or older. Increasing age was associated with an increase in all-cause in-hospital mortality, contrast-induced nephropathy, transfusion, stroke/transient ischemic attack, and vascular complications. The overall in-hospital mortality rate was 1.09% and increased from 0.67% in those younger than 70 years up to 5.44% in those 90 years old or greater. The mortality rate in patients over 80 years approached 12% to 15% for those with ST-segment myocardial infarction and 39% in cardiogenic shock patients. CONCLUSIONS The proportion of elderly patients referred for PCI is increasing. Procedural complications increase with age, and patients presenting with unstable symptoms are at the highest risk.
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Affiliation(s)
- Michael P Thomas
- Division of Cardiovascular Medicine, University of Michigan Medical School, Ann Arbor, Michigan 48109-5853, USA
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Chait R, Zad O, Ramineni R, Shukla A, Mitchell A. Midterm outcomes and quality of life following percutaneous coronary intervention in nonagenarians. Am J Cardiol 2011; 107:1609-12. [PMID: 21420046 DOI: 10.1016/j.amjcard.2011.01.046] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Revised: 01/20/2011] [Accepted: 01/20/2011] [Indexed: 11/27/2022]
Abstract
The midterm clinical and functional benefits of percutaneous coronary intervention in patients aged ≥90 years have not been clearly defined. From January 2005 to June 2009, 173 patients aged ≥90 years underwent diagnostic cardiac catheterization, of whom 90 underwent percutaneous coronary intervention. There were 45 men (50%) and 45 women (50%), with a mean age of 92 years (range 90 to 101). Of these, 24 patients (27%) presented with ST-segment elevation myocardial infarction, 31 (34%) with non-ST-segment elevation myocardial infarction, 28 (31%) with unstable angina pectoris, and 2 (2%) with stable angina pectoris; 5 patients (6%) were studied for preoperative risk assessment. A total of 127 lesions were successfully treated using 102 drug-eluting stents and 37 bare-metal stents, with a mean of 1.5 stents per patient. Postprocedural complications included renal insufficiency in 5 patients (5.6%), heart failure in 6 patients (6.7%), and cardiogenic shock in 2 patients (2.2%). Seventy-seven patients (85.6%) experienced no postprocedural complications. In-hospital mortality was 7.8%, and actuarial survival was 61.5 ± 5.2% at 24 months and 31.6 ± 6.1% at 48 months. The SF-36 Health Survey was administered at follow-up, and results demonstrated a quality of life similar to that of the general population corrected for age and gender. In conclusion, this study demonstrates that percutaneous coronary intervention in nonagenarians can be accomplished with low mortality and morbidity and excellent midterm results. Moreover, functional improvement in nonagenarians supports enhanced quality of life comparable to that of the general population.
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Appleby CE, Ivanov J, Mackie K, Džavík V, Overgaard CB. In-hospital outcomes of very elderly patients (85 years and older) undergoing percutaneous coronary intervention. Catheter Cardiovasc Interv 2011; 77:634-41. [DOI: 10.1002/ccd.22729] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Revised: 06/21/2010] [Accepted: 06/30/2010] [Indexed: 11/05/2022]
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Sung LC, Wang JH. A Very Elderly Woman Experiencing Two Episodes of Acute Myocardial Infarction Treated by Percutaneous Coronary Intervention: A Case Report and Literature Review. INT J GERONTOL 2010. [DOI: 10.1016/s1873-9598(10)70039-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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LEMESLE GILLES, BONELLO LAURENT, DE LABRIOLLE AXEL, STEINBERG DANIELH, ROY PROBAL, SLOTTOW TINALPINTO, TORGUSON REBECCA, KANESHIGE KIMBERLY, XUE ZHENYI, SUDDATH WILLIAMO, SATLER LOWELLF, KENT KENNETHM, LINDSAY JOSEPH, PICHARD AUGUSTOD, WAKSMAN RON. Impact of Bivalirudin Use on Outcomes in Nonagenarians Undergoing Percutaneous Coronary Intervention. J Interv Cardiol 2009; 22:61-7. [DOI: 10.1111/j.1540-8183.2008.00422.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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From AM, Rihal CS, Lennon RJ, Holmes DR, Prasad A. Temporal Trends and Improved Outcomes of Percutaneous Coronary Revascularization in Nonagenarians. JACC Cardiovasc Interv 2008; 1:692-8. [DOI: 10.1016/j.jcin.2008.07.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2008] [Revised: 07/16/2008] [Accepted: 07/30/2008] [Indexed: 11/28/2022]
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