"Do Least Harm" Philosophy May Suffice for Percutaneous Coronary Intervention in Octogenarians

The influence of complete coronary revascularization on long-term outcomes in patients with multivessel coronary heart disease undergoing successful percutaneous coronary intervention

The influence of complete revascularization (CR) compared with incomplete revascularization (ICR) on long-term outcomes was assessed in patients with multivessel coronary heart disease undergoing successful percutaneous coronary intervention (PCI). A retrospective analysis of the clinical data, lesion type and PCI data was carried out in 324 patients with multivessel coronary heart disease (CR group, 99 patients; ICR group, 225 patients). Major adverse cardiac events (MACE) were recorded at follow-up (mean +/- SD follow-up interval, 18 +/- 7.1 months). There were no significant differences in clinical characteristics between the two groups at follow-up, although the CR group showed a non-significant tendency to a higher incidence of non-fatal myocardial infarction, cardiac death, repeated revascularization and MACE compared with the ICR group. In conclusion, the long-term prognosis for ICR was not inferior to that for CR in patients with multivessel coronary heart disease undergoing successful PCI.

Outcome in the elderly undergoing percutaneous coronary intervention with sirolimus-eluting stents: results from the prospective multicenter German Cypher Stent Registry

BACKGROUND

Patients older than 75 years undergoing percutaneous coronary interventions are at increased risk for major adverse cardiac events strongly influenced by comorbidities. In various randomized trials, sirolimus-eluting stent (SES) implantation has been shown to decrease the incidence of in-stent restenosis and to reduce repeat revascularization regardless of patient age.

METHODS

The present study evaluates the outcome after SES implantation in 954 patients older than 75 years compared with 5801 patients younger than 75 years enrolled in the German Cypher Registry in a routine clinical setting.

RESULTS

The elderly were at higher risk regarding renal failure, diabetes, hypertension, impaired left ventricular function, and 3-vessel disease. The SES implantation resulted in an impressive relief of angina. As expected, in-hospital and 6-month mortality rates were higher in the elderly. However, there was no difference with respect to the rate of major adverse cardiac events (death, myocardial infarction, ischemia-driven target vessel revascularization) at 6-month follow-up.

CONCLUSIONS

Nonfatal complications such as myocardial infarction or repeat target vessel revascularization did not increase with age, even taking patients older than 80 years into account.