The octogenarian population has already reached 137 million and continues to grow. It is estimated to triple by 2050.
This increase represents a big challenge, seeing as these patients are often more fragile, present more complex coronary artery disease and multiple comorbidities. This generally requires two or more procedures and more experience both from operators and the whole health team.
2,657 octogenarian patients were randomized, 1,387 received complex percutaneous coronary intervention (C PCI).
Primary end point was a composite of all-cause mortality, myocardial infarction (MI) or target vessel revascularization (TVR) (MACE) at 12 months.
Mean patient age was 84, with 36% diabetic and no significant differences in kidney function. Those receiving complex PCI were more often women, smoker, hypertensive, with dyslipidemia, prior MI, prior PCI, prior CABS, atrial fibrillation and lower ejection fraction.
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The most frequent clinical presentation was stable chronic angina, followed by unstable angina, non-ST elevation acute MI (NTEMI), ST elevation MI (STEMI), and, less frequently, silent ischemia.
Most procedures were femoral (84%). Patients with C PCI commonly presented left main lesions, multivessel disease, lesions to the anterior descending, calcified lesions, bifurcations, longer lesions, more stents, longer stents and the need for ventricular assistance, as well as higher SYNTAX score (20.8 vs. 10.7, p<0.001).
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Primary end point resulted higher in patients undergoing C PCI (16.6% vs. 11.1%, p<0.001), as well as MI incidence (4.1% vs. 1.5%, p=0.002) and TVR (8.9% vs. 4.4%, p<0.001), with no differences in all-cause mortality. Also these patients presented a higher incidence of TLR and major bleeding with no differences in post discharge stroke or major bleeding incidence.
Conclusion
Octogenarian undergoing complex PCI are associated to higher risk of major adverse cardiovascular events (MACE) at one year, because of higher MI and TVF rate, as well as higher incidenc of major bleeding, with no difference in all-cause mortality vs. pateints undergoing non-complex PCI. We should implement strategies to reduce complications in octogenarian patients undergoing complex PCI.
Dr. Carlos Fava.
Member of the Editorial Board of SOLACI.org.
Original Title: Prevalence and prognostic impact of complex percutaneous coronary intervention among octogenarians.
Reference: Alessandro Spirito, et al. Catheter Cardiovasc Interv. 2024;103:1079–1087.
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