In-Hospital and Short-Term Outcomes of Percutaneous Coronary Intervention in Patients Older Than 65 Years Old: Results from Tanta PCI Registry
Mohammed Salah Kasem *
Cardiovascular Medicine Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
Seham Fahmy Badr
Cardiovascular Medicine Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
Hanan Kamel Kassem
Cardiovascular Medicine Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
Mahmoud Zaki El-Amrosy
Cardiovascular Medicine Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
Randa Mohammed Abdel-Majid
Cardiovascular Medicine Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
*Author to whom correspondence should be addressed.
Abstract
Background: Percutaneous coronary intervention (PCI) outcomes in elderly people are more challenging due to several factors. This study aimed to investigate in-hospital and short-term outcomes of PCI in elderly people aged more than 65 years old, presented to cardiology department of Tanta university hospitals during study period.
Methods: This case-control study was carried out on 935 patients presenting for elective PCI procedure and those suffering from high-risk ACS either ST segment elevation myocardial infarction (STEMI), non-ST segment elevation myocardial infarction (NSTEMI) or unstable angina treated with urgent PCI. Patients were divided into 4 groups: group II: included 326 patients aged from 65 to 69 years old, group III: included 160 patients aged from 70 to 74 years old, group IV: Included 99 patients aged ≥ 75 years old and group I (control): included 350 patients aged < 65 years old. All patients were subjected to ECG, echocardiography, basic labs, coronary angiography and PCI.
Results: Mortality, dissection, perforation, CIN, hemorrhage, heart failure and cardiogenic shock were significantly different among STEMI patients’ groups (P ≤ 0.05). CVS, Heart failure and Cardiogenic shock were significantly different among NSTE-ACS patients’ groups (P ≤ 0.05). Loss of follow up and mortality were significantly different among NSTE-ACS patients’ groups. Age, diabetes mellitus, hypertension, multi-vessel diseases, dissection, perforation and major bleeding were significant predictors of mortality among elective PCI patients (P ≤ 0.05). Age, diabetes mellitus, hypertension, chronic kidney diseases that necessitates dialysis, dyslipidemia multi-vessel diseases, left main artery, final TIMI 0, final TIMI I dissection, perforation, and major bleeding were significant predictors of mortality among ACS PCI patients (P ≤ 0.05).
Conclusions: In spite that PCI in elderly people still challenging, with poorer outcomes especially among those older than 75 years of age, newer generations of drug-eluting stents, and wide-availability of the safer radial artery access reduced the risk of PCI-related major adverse cardiovascular events and improved the long-term clinical outcomes in elderly patients suffering from both high-risk chronic and ACS.
Keywords: Percutaneous coronary intervention, myocardial infarction, acute coronary syndrome, sepsis