In the Journals

PCI increases risk for in-hospital mortality in octogenarian patients

Patients aged at least 80 years who underwent PCI had an increased risk for in-hospital mortality and morbidity compared with those younger than 80 years, according to a study published in The American Journal of Cardiology.

“The decision to proceed with PCI in this patient population should be individualized, taking into consideration known risk factors and patients’ wishes,” Yasser Al-khadra, MD, clinical assistant professor in the department of internal medicine at Cleveland Clinic, and colleagues wrote.

Researchers analyzed data from 11,056,559 patients from the National Inpatient Sample database who underwent PCI between 2002 and 2014. Patients were categorized as aged at least 80 years (n = 1,544,563; mean age, 62 years; 34% women) or younger than 80 years (n = 9,511,996; mean age, 84 years; 50% women).

The primary outcome was in-hospital mortality. Secondary outcomes included bleeding requiring blood transfusion, length of stay, postoperative stroke, cardiac complications, vascular complications, respiratory complications, postprocedural thromboembolic complications and acute kidney injury.

Compared with those younger than 80 years, those aged at least 80 years had higher rates of in-hospital mortality (3.3% vs. 1.3%; adjusted OR = 1.62; 95% CI, 1.6-1.64) after adjusting for procedure urgency, demographics, patients’ insurance, comorbidities and socioeconomic status, the researchers reported. Older patients also had a longer hospital stay compared with younger patients (3 days vs. 2 days; P < .001).

Patients aged at least 80 years had higher incidence of respiratory complications (2.8% vs. 2.1%; aOR = 0.92; 95% CI, 0.91-0.93), cardiac complications (3.4% vs. 2.4%; aOR = 1.07; 95% CI, 1.06-1.08) and postprocedural thromboembolic complications (16.7% vs. 10.8%; aOR = 1.24; 95% CI, 1.23-1.24) compared with those younger than 80 years, according to the study. These patients also had higher rates of postprocedural stroke (6.3% vs. 3.8%; aOR = 1.32; 95% CI, 1.31-1.33), acute kidney injury (8.9% vs. 4.6%; aOR = 1.52; 95% CI, 1.5-1.53) and bleeding requiring transfusion (2.1% vs. 1%; aOR = 1.3; 95% CI, 1.28-1.32). There was no difference between the older and younger groups for vascular complications (aOR = 1; 95% CI, 0.99-1.02).

“The consistency in worse outcome in octogenarian patients over the course of many years despite advances in imaging and interventional techniques emphasizes the point that the elderly patients should be approached differently compared with younger population,” Al-khadra and colleagues wrote. “Radial access to minimize bleeding risk, culprit-only intervention, less use of thrombolytics and glycoprotein IIb/IIIa inhibitors, less contrast volume, proper pre- and post-PCI hydration, discussing goals of care with the patients and their families and careful patient selection for high risk and long interventions are all important points to keep in mind when referring elderly patients for PCI.” – by Darlene Dobkowski

Disclosures: The authors report no relevant financial disclosures.

 

Patients aged at least 80 years who underwent PCI had an increased risk for in-hospital mortality and morbidity compared with those younger than 80 years, according to a study published in The American Journal of Cardiology.

“The decision to proceed with PCI in this patient population should be individualized, taking into consideration known risk factors and patients’ wishes,” Yasser Al-khadra, MD, clinical assistant professor in the department of internal medicine at Cleveland Clinic, and colleagues wrote.

Researchers analyzed data from 11,056,559 patients from the National Inpatient Sample database who underwent PCI between 2002 and 2014. Patients were categorized as aged at least 80 years (n = 1,544,563; mean age, 62 years; 34% women) or younger than 80 years (n = 9,511,996; mean age, 84 years; 50% women).

The primary outcome was in-hospital mortality. Secondary outcomes included bleeding requiring blood transfusion, length of stay, postoperative stroke, cardiac complications, vascular complications, respiratory complications, postprocedural thromboembolic complications and acute kidney injury.

Compared with those younger than 80 years, those aged at least 80 years had higher rates of in-hospital mortality (3.3% vs. 1.3%; adjusted OR = 1.62; 95% CI, 1.6-1.64) after adjusting for procedure urgency, demographics, patients’ insurance, comorbidities and socioeconomic status, the researchers reported. Older patients also had a longer hospital stay compared with younger patients (3 days vs. 2 days; P < .001).

Patients aged at least 80 years had higher incidence of respiratory complications (2.8% vs. 2.1%; aOR = 0.92; 95% CI, 0.91-0.93), cardiac complications (3.4% vs. 2.4%; aOR = 1.07; 95% CI, 1.06-1.08) and postprocedural thromboembolic complications (16.7% vs. 10.8%; aOR = 1.24; 95% CI, 1.23-1.24) compared with those younger than 80 years, according to the study. These patients also had higher rates of postprocedural stroke (6.3% vs. 3.8%; aOR = 1.32; 95% CI, 1.31-1.33), acute kidney injury (8.9% vs. 4.6%; aOR = 1.52; 95% CI, 1.5-1.53) and bleeding requiring transfusion (2.1% vs. 1%; aOR = 1.3; 95% CI, 1.28-1.32). There was no difference between the older and younger groups for vascular complications (aOR = 1; 95% CI, 0.99-1.02).

“The consistency in worse outcome in octogenarian patients over the course of many years despite advances in imaging and interventional techniques emphasizes the point that the elderly patients should be approached differently compared with younger population,” Al-khadra and colleagues wrote. “Radial access to minimize bleeding risk, culprit-only intervention, less use of thrombolytics and glycoprotein IIb/IIIa inhibitors, less contrast volume, proper pre- and post-PCI hydration, discussing goals of care with the patients and their families and careful patient selection for high risk and long interventions are all important points to keep in mind when referring elderly patients for PCI.” – by Darlene Dobkowski

Disclosures: The authors report no relevant financial disclosures.