Long-term clinical outcome after percutaneous coronary interventions in the elderly: results for 512 consecutive patients

Combination of angiographic and clinical characteristics for the prediction of clinical outcomes in elderly patients undergoing multivessel PCI

BACKGROUND

Risk stratification is essential for the clinical decision-making process in elderly patients undergoing multivessel revascularization, since the optimal revascularization strategy remains subject of ongoing debate.

AIMS

To assess the prognostic value of angiographic versus clinical characteristics for the prediction of a first adverse cardiac and cerebrovascular events (MACCE) (all-cause mortality, non-fatal myocardial infarction, stroke, and target lesion revascularization) and to develop a combined risk model.

METHODS

After multivessel percutaneous coronary intervention (MV-PCI), SYNTAX score and EuroSCORE were calculated as combined risk model in 328 elderly patients who were followed up for a first MACCE.

RESULTS

328 patients with a mean age of 77.5 ± 5.1 years were followed up for 2.7 ± 1.5 years. A first MACCE occurred in 50.0 % (164/328) of the patients. To improve predictability, a combined risk score model with receiver operating characteristic curve validated cut-off values for EuroSCORE (>5 %) and SYNTAX score (>25) was developed. High risk patients had a 3.5-fold higher risk for MACCE after 3 years (HR 7.1, 95 % CI 1.9-6.5; p < 0.001).

CONCLUSIONS

For adequate risk assessment in elderly patients undergoing MV-PCI, consideration of both comorbidities and coronary anatomic complexity is essential. A combined angiographic and clinical risk score provides superior prediction of 3-year MACCE risk in elderly patients.