All-Cause Heart Failure Rehospitalization outcomes

Hospitalization Outcomes Among Nonagenarians Undergoing PCI after AMI

November 2, 2017

Key Takeaways

  • Elderly patients between ages 90 and 99 have a high risk for mortality after percutaneous coronary intervention (PCI) compared with younger patients.
  • This study evaluated nonagenarians from the Veterans Affairs Clinical Assessment, Reporting, and Tracking program undergoing PCI (n = 274) and evaluated mortality outcomes (30 days and 1 year) and predictors of mortality.
  • There was worse 30-day and 1-year mortality among nonagenarians after risk adjustment, demonstrating the effects of their higher age-related comorbidities on outcomes.

Reference: Sawant AC et al. JACC Cardiovasc Interv. 2017;10(13):1295-1303.

Several studies have suggested early revascularization to be associated with favorable outcomes in elderly patients with cardiogenic shock complicating acute myocardial infarction (CS-AMI).1,2 Early revascularization for patients serves multiple purposes. First, early reperfusion may reduce the amount of ischemic myocardial injury. Secondly, a timely reperfusion approach may improve ventricular electrical stability.

Nonagenarians, persons who are between the ages of 90 and 99, are at higher risk for mortality following PCI.3 A study by Sawant et al pooled data of nonagenarian veterans undergoing PCI (n = 274) from the Veterans Affairs Clinical Assessment, Reporting, and Tracking for Cardiac Catheterization Laboratories (CART-CL) program to assess temporal trends, mortality outcomes (30 days and 1 year), and predictors of mortality.4

According to an editorial by Holmes,5 the consecutive and comprehensive nature of the Veterans Affairs system improves the structure of this study because, “...[the Veterans Affairs system] deals with perhaps more of a ‘captive’ population with more distinct characteristics by virtue of their typically being veterans.”

Patients in this cohort had a lower body mass index compared with younger patients, representing the frailty of this patient population. Nonagenarians were also less likely to have diabetes but were more likely to have a history of hypertension, cerebrovascular disease, and chronic kidney disease. Additionally, nonagenarians were more likely to present with cardiogenic shock (2.6% vs 0.5%; p < 0.001) and have a higher incidence of renal failure compared with younger patients (31.8% vs 10.3%; p < 0.001).

Overall complication rates post-PCI were low, with no in-laboratory events of MI, death, stroke, or coronary perforation. Compared with younger patients, there were significantly more incidences of no reflow (2.9% vs 1%; p = 0.02) and acute cardiogenic shock (0.73% vs. 0.12%; p = 0.04) post-PCI.

Unadjusted post-procedural and all-cause mortality at 30 days and 1 year were 1.4% and 4.2% among all veterans undergoing PCI. Crude 30-day and 1-year mortality was significantly higher in nonagenarians than younger patients (10.6% vs 1.4%; p < 0.0001 vs 16.3% vs 4.2%; p < 0.0001, respectively). Prior cardiogenic shock was associated with a greater incidence of death at 30 days (13.8% vs 0.4%, p<0.001). There was worse 30-day (odds ratio [OR]: 2.14; 95% confidence interval [CI]: 1.42 to 3.22) and 1-year mortality (OR: 1.82; 95% CI: 1.27 to 2.62) among nonagenarians after risk adjustment, demonstrating the effects of these patients’ higher age-related comorbidities on outcomes.

References:

  1. Lim HS, Farouque O, Andrianopoulos N, et al. Survival of elderly patients undergoing percutaneous coronary intervention for acute myocardial infarction complicated by cardiogenic shock. JACC Cardiovasc Interv. 2009;2(2):146-152.
  2. Rogers PA, Daye J, Huang H, et al. Revascularization improves mortality in elderly patients with acute myocardial infarction complicated by cardiogenic shock. Int J Cardiol. 2014;172(1):239-241.
  3. Lee MS, Zimmer R, Pessegueiro A, Jurewitz D, Tobis J. Outcomes of nonagenarians who undergo percutaneous coronary intervention with drug-eluting stents. Catheter Cardiovasc Interv. 2008;71(4):526-530.
  4. Sawant AC, Josey K, Plomondon ME, et al. Temporal Trends, Complications, and Predictors of Outcomes Among Nonagenarians Undergoing Percutaneous Coronary Intervention: Insights From the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program. JACC Cardiovasc Interv. 2017;10(13):1295-1303.
  5. Holmes DR Jr. Four Score and 10 Years. JACC Cardiovasc Interv. 2017;10(13):1304-1306.

NPS-109-17

Subscribe to the Digital Community

Receive weekly updates including case review videos, tips and tricks, specialists opinions, and resources and downloads regarding Protected PCI and Cardiogenic Shock.

Subscribe to the Digital Community

Receive weekly updates including case review videos, tips and tricks, specialists opinions, and resources and downloads regarding Protected PCI and Cardiogenic Shock.