Percutaneous coronary intervention in the elderly: a comparison of procedural and clinical outcomes between the eighth and ninth decades

AIMS: To compare short-term safety and outcome of percutaneous coronary intervention (PCI) in the elderly in their ninth decade with those in their eighth decade. METHODS: Five-hundred and eighty-nine patients aged 70 years undergoing coronary angioplasty were stratified into two groups, those 80 years old (Group 1, n = 65) and those 70Eth 79 years old (Group 2, n = 524). RESULTS: Group 1 comprised more females than Group 2 (57% vs. 40%, respectively; p = 0.009), patients with hypertension (70% vs. 56%, respectively), untreated hyperlipidemia (18% vs. 7%, respectively), acute coronary syndromes (75% vs. 53%, respectively) and multi-vessel disease (63% vs. 54%, respectively). Angiographic success per lesion was similar in Groups 1 and 2 (96% vs. 99%, respectively) as was clinical success per lesion (89% vs. 89%, respectively). Groups 1 and 2 also had a similar incidence of in-hospital death (1.5% vs. 1.1%, respectively), Q-wave myocardial infarction (0.0% vs. 0.6%, respectively), non-Q wave myocardial infarction (6.2% vs. 2.9%, respectively), emergency coronary artery bypass surgery (0.0% vs. 1. 3%, respectively), repeat PCI (3.0% vs. 1.7%, respectively), stroke (1.5% vs. 0.4%, respectively) and local vascular complications (4.6% vs. 4.4%, respectively). However, Group 1 had a longer in-hospital stay (4 days) than Group 2 (2 days) (p < 0.001). CONCLUSION: Our data suggest that short-term procedural and clinical outcomes after PCI are similar for patients in their eighth decade compared to those in their ninth decade.     

Percutaneous coronary intervention via the radial artery: comparison of procedural success in emergency versus non-emergency cases

BackgroundSTEMI and unstable acute coronary syndromes are associated with widespread adrenergic activation which may increase radial artery (RA) spasm, requiring cross-over to the femoral artery (FA) during percutaneous coronary intervention (PCI). We assessed the incidence of failed trans-radial artery PCI in emergency cases compared with non-emergency cases.MethodsPCI procedures performed by default radial artery operators were assessed in our centre over a 25 month period. Those who had both RA and FA access were identified to assess if the double punctures were elective or due to failure of the RA approach. Cross-over rates were compared between emergency and non-emergency cases.Results680 cases of PCI were performed, 153 in an emergency setting. In non-emergency cases 403/527 (76.5%) were performed via the RA. In the emergency setting 139/153 (90.8%) were completed by the RA. Previous CABG with multiple arterial conduits was the most common reason for elective FA PCI in both groups. The RA to FA cross-over rate was low with no significant difference between the emergency and non-emergency groups (emergency 1.4%, non-emergency 1.2%, p = 1.0). In both groups there was no significant difference between RA and FA procedures in terms of fluoroscopy times (emergency: mean 13.1 ± 7.9 min vs 16.1 ± 16.1 min, p = .25, non-emergency: 16.6 ± 10.3 min vs 18.7 ± 13.6 min, p = .07) or contrast volumes (emergency: mean 231 ± 126 ml vs 229 ± 102 ml, p = .77, non-emergency: 223 ± 85 ml vs 237 ± 91 ml, p = .15).ConclusionsThe vast majority of PCI can be successfully performed via the RA. Cross-over rates to the FA are low and are not more common in emergency patients.     

高龄冠心病患者的经皮冠状动脉介入治疗

目的 :总结高龄冠心病介入治疗的经验。方法 :回顾分析我院 1997年 2月至 2 0 0 1年 12月连续 12 6例 70岁以上的冠心病病人的介入治疗资料 ,其中多支病变占 89 7%。 193处靶病变行PTCA、冠状动脉支架、切割球囊扩张和旋磨 ,其中复杂病变占 86 5 %。结果 :病例成功率 95 2 % ,病变成功率93 3%。其中 33例急性心肌梗死介入治疗梗塞相关血管开通率 10 0 %。慢性闭塞病变 2 1处 ,成功率81 0 %。 112例病人行冠状动脉支架术 (占 88 9% )。术前靶血管平均狭窄 (85 6± 11 3) % ,术后平均残余狭窄 (5 2± 6 1) %。严重并发症率 4 0 % ,其中死亡率 2 4 %。 1例 (0 8% )行紧急冠脉架桥术 ;1例(0 8% )Q波心梗。急性闭塞 5例 (4 0 % ) ,心包填塞 1例 (0 8% ) ;5例 (4 0 % )病人出现消化道出血 ,1例(0 8% )病人发生脑出血。结论 :70岁以上的高龄冠心病人的介入治疗成功率高、并发症的发生率也是可以接受的     

老年冠心病患者的介入治疗

冠心病是目前中国老年人心脏病住院和死亡的第一位原因。由于年龄因素及合并其他慢性疾病,老年冠心病患者的治疗往往更加困难。随着技术的进步和经验的积累,越来越多的老年患者接受经皮冠状动脉介入治疗,且取得了很好的疗效。本期专栏所刊登的文章重点向大家介绍了我国老年急性心肌梗死和慢性完全闭塞病变等危重冠心病患者介入治疗方面的进展,以及血管内超声在老年冠心病患者介入诊治中的应用。因此,老年危重冠心病患者可以从介入治疗中受益。     

老年人冠心病经皮冠状动脉介入治疗

随着我国逐渐步入老龄化社会,老年冠心病患者的人数日益增加。相对于非老年群体,老年冠心病患者心血管事件的危险因素更多,冠状动脉介入治疗术后的血栓和出血风险更大,因此老年冠心病患者的冠心病介入治疗需要得到更多的关注。本文回顾了老年冠心病患者接受冠状动脉介入治疗的相关进展,并提出老年冠心病介入治疗工作的改进建议。     

Percutaneous coronary intervention in tortuous coronary arteries: associated complications and strategies to improve success

Percutaneous intervention of tortuous coronary arteries can be challenging. We describe four cases that illustrate complications associated with coronary tortuosity (coronary dissection and stent loss) and strategies that can improve procedural success (such as use of soft delivery catheters, deep guide intubation, meticulous vessel preparation, and use of short, thin-strut stents).     

老年急性冠脉综合征患者介入治疗的临床分析

目的：探讨老年急性冠脉综合征(ACS)患者接受经皮冠状动脉介入治疗(PCI)的临床价值。方法：70岁以上老年ACS患者50例,对持续性胸痛伴(或)ST段抬高心肌梗死患者(AMI 2例,UA2例)行急诊PCI；对非ST段抬高ACS患者经规范内科治疗病情平稳1周后行PCI。结果：对70支罪犯血管进行PTCA术后置入81枚支架。49例患者随访8～24个月无心绞痛发作；1例术后2个月冠脉造影显示支架内再狭窄,经支架内再支架置入术后随访5个月无心绞痛发作。结论：对老年ACS患者及时进行PCI可获得良好效果,临床安全程度高。     

老年冠心病介入治疗的若干问题

我国目前60岁以上人口为1.26亿,占总人口10%左右,65岁以上为8600万,占7%,人口年龄结构已进入老龄化,预计到2015年,60岁以上人口超过2亿(14%).     

老年急性冠脉综合征患者介入治疗的临床分析

目的:探讨老年急性冠脉综合征(ACS)患者接受经皮冠状动脉介入治疗(PCI)的临床价值.方法:70岁以上老年ACS患者50例,对持续性胸痛伴(或)ST段抬高心肌梗死患者(AMI 2例,UA2例)行急诊PCI;对非ST段抬高ACS患者经规范内科治疗病情平稳1周后行PCI.结果:对70支罪犯血管进行PTCA术后置入81枚支架.49例患者随访8～24个月无心绞痛发作;1例术后2个月冠脉造影显示支架内再狭窄,经支架内再支架置入术后随访5个月无心绞痛发作.结论:对老年ACS患者及时进行PCI可获得良好效果,临床安全程度高.     

Percutaneous coronary intervention versus coronary artery bypass grafting: clinical outcomes in multivessel coronary artery disease

Revascularization with percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) is superior to medical management in reducing symptoms and prolonging exercise duration in patients with coronary artery disease (CAD). Ten randomized trials have compared the outcomes in percutaneous and surgically treated patients with multivessel CAD. The purpose of this article was to summarize the results of those trials to make recommendations regarding appropriate revascularization strategy.     

65岁以上老年患者冠状动脉介入治疗单中心随访研究

目的 观察年龄＞65岁老年患者经皮冠状动脉介入(PCI)的远期疗效.方法 将2003年1月至2005年1月在上海交通大学医学院附属瑞金医院心脏科行PCI治疗并完成随访的1012例患者根据年龄分为＞65岁组(583例)和≤65岁组(429例),记录各组患者的一般资料、临床特征和冠状动脉造影及PCI情况.术后每3个月通过随访记录患者所有原因病死、中风和主要心脏不良事件.比较＞65岁组患者药物洗脱支架和普通金属支架的临床疗效.结果 与年龄≤65岁组比较,年龄＞65岁组患者女性较多、体重较轻、吸烟史少,但高血压病及慢性肾功能不全多见,而且冠状动脉病变程度严重、PCI同期行肾动脉支架术患者增多、完全血运重建率和药物洗脱支架置入比例较低.平均随访17个月,年龄＞65岁组与年龄≤65岁组比较,主要心脏不良事件(12.52%对8.62%,P＜0.05)、所有原因病死率(5.83%对1.17%,P＜0.01)和所有不良事件(15.27%对9.09%,P＜0.01)发生率均增高.年龄＞65岁组患者中,药物洗脱支架组较普通金属支架组主要心脏不良事件发生率显著减少(10.14%对16.51%,P＜0.05),但心源性病死率(3.01%对4.59%,P＞0.05)和所有原因病死率(5.48%对6.42%,P＞0.05)差异无显著性意义.结论 年龄＞65岁老年患者冠状动脉支架术后远期心脏事件和所有原因病死率显著增加;药物洗脱支架可明显降低主要心脏不良事件发生率,但不能减少心源性和非心源性死亡.     

Percutaneous coronary intervention in the elderly: a growing need for a growing population

Persons aged 80 and above are the fastest growing age group in the United States population, having increased 50% since 1990 and predicted to grow another 25 % by 2020. As this aging population grows, heart disease remains the leadine cause of death, accounting for     

Percutaneous coronary intervention in octogenarians: 10-year experience from a primary percutaneous coronary intervention centre with off-site cardiothoracic support

OBJECTIVETo examine the trends in patient characteristics and clinical outcomes over a ten-year period and to analyse the predictors of mortality in octogenarians undergoing percutaneous coronary intervention (PCI) in our centre.METHODSA total of 782 consecutive octogenarians (aged 80 and above) were identified from a prospectively collected PCI database within our non-surgical, medium volume centre between 1st January 2007 and 31st December 2016. This represented 10.9% of all PCI procedures performed in our centre during this period. We evaluated the demographic and procedural characteristics of the cohort with respect to clinical outcomes (all-cause in-hospital and 1-year mortality, in-hospital complication rates, duration of hospital admission, coronary disease angiographic complexity and major co-morbidities). The cohort was further stratified into three chronological tertiles (January 2007 to July 2012, 261 cases; August 2012 to May 2015, 261 cases; June 2015 to December 2016, 260 cases) to assess for differences over time. Predictors of mortality were identified through a multivariate regression analysis.RESULTSThe number of octogenarians undergoing PCI increased nearly ten-fold over the studied period. Despite this, there were no significant differences in clinical outcomes or patient characteristics, except for the increased use of trans-radial vascular access [11.9% in first tertile vs. 73.2% in third tertile (P < 0.0001)]. The all-cause in-hospital (5.8% vs. 4.6% vs. 3.8%, P = 0.578) and 1-year mortality (12.4% vs. 12.5% vs. 14.4%, P = 0.746) remained constant in all three tertiles respectively. Six independent predictors of mortality were identified - increasing age [HR = 1.12 (1.03−1.22), P = 0.008], cardiogenic shock [HR = 16.40 (4.04–66.65), P < 0.0001], severe left ventricular impairment [HR = 3.52 (1.69−7.33), P = 0.001], peripheral vascular disease [HR = 2.73 (1.22−6.13), P = 0.015], diabetes [HR = 2.59 (1.30−5.17), P = 0.007] and low creatinine clearance [HR = 0.98 (0.96−1.00), P = 0.031]. CONCLUSIONThis contemporary observational study provides a useful insight into the real-world practice of PCI in octogenarians.

Although age is a major cardiovascular risk factor which has a marked impact on the prevalence of coronary artery disease (CAD) and cardiovascular mortality,^[1] there is a recognised reluctance in offering percutaneous coronary intervention (PCI) to octogenarians (≥ 80 years old),^[2] despite its proven benefit in this age group.^[3–5] As a result, an increasing number of octogenarians undergoing PCI is observed, reaching almost 10% of all PCI procedures performed in United Kingdom in the period 2008–2012.^[6]Despite the increasing demand for PCI in the octogenarians, this patient population remains under-represented in randomised trials or only a highly selected group is investigated.^[7,8] Emerging evidence shows that the survival advantage of invasive compared with non-invasive management appears to extend to patients with non-ST elevation myocardial infarction (NSTEMI) who are octogenarians,^[4,9] although predictably, mortality rates are higher in patients undergoing primary PCI for STEMI.^[10]In the absence of robust randomised clinical data on PCI treatment strategies for the octogenarians, observational studies remain valuable in providing insights to outcome and mortality trends. As a result, we aimed to evaluate the characteristics of our “real world” octogenarian patient population presenting over a ten-year period to a PCI centre with off-site cardiothoracic support in terms of demographics, the procedural and clinical outcomes, and any potential predictors of mortality.     

Bleeding outcomes after non-emergency percutaneous coronary intervention in the very elderly

Background Octogenarians constitute an increasing proportion of patients presenting for non-emergency percutaneous coronary intervention (PCI). Methods This study evaluated the in-hospital procedural characteristics and outcomes, including the bleeding events of 293 octogenarians presenting between January 2010 and December 2012 for non-emergency PCI to a single large volume tertiary care Australian center. Comparisons were made with 293 consecutive patients aged less than or equal to 60 years, whose lesions were matched with the octogenarians. Results Non-ST elevation myocardial infarction was the most frequent indication for non-emergency PCI in octogenarians. Compared to the younger cohort, they had a higher prevalence of co-morbidities and more complex coronary disease, comprising more type C and calcified lesions. Peri-procedural use of low molecular weight heparin (LMWH; 1.0% vs. 5.8%; P < 0.001) and glycoprotein IIb/IIIa inhibitors (2.1% vs. 9.6%; P < 0.001) was lower, while femoral arterial access was used more commonly than in younger patients (80.9% vs. 67.6%; P < 0.001). Overall, there was a non-significant trend towards higher incidence of all bleeding events in the elderly (9.2% vs. 5.8%; P = 0.12). There was no significant difference in access site or non-access site bleeding and major or minor bleeding between the two cohorts. Sub-analysis did not reveal any significant influence on bleeding rates by the use of LMWH, glycoprotein IIb/IIIa inhibitors or femoral arterial access. In addition, there were no significant differences in the rates of in-hospital mortality, stroke or acute stent thrombosis between the two groups. Conclusions In this single center study, we did not observe significant increases in adverse in-hospital outcomes including the incidence of bleeding in octogenarians undergoing non-emergency PCI.