Technical Success of CTO-PCI Not Impacted by Age. ACC. 16
Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) procedures achieved high technical success rates among all age groups examined in a multicenter U.S. registry study of more than 1,000 cases; however, the oldest patients (≥75 years) were more likely than the younger patients to suffer major adverse cardiac events (MACE). The study results were presented April 2 at the American College of Cardiology Scientific Sessions in Chicago.
Rahel Iwnetu, MD, and colleagues at the VA North Texas Healthcare System in Dallas studied clinical, angiographic and outcomes data of 1,216 CTO-PCI procedures performed in 1,195 patients whom they grouped by age (<65, 65-74 and ≥75 years).
The researchers found little difference in the technical success of procedures or in procedure time, contrast volume or air kerma radiation dose across the age groups. Patients in the ≥75 years old group did, however, have higher incidence of MACE (0.9% vs. 3.0% vs. 5.1%, p=0.002) largely due to higher rate of cardiac tamponade requiring emergency pericardiocentesis.
|Table. Procedural Characteristics and Outcomes According to Age Group|
|Variable||Age <65||Age 65-74||Age ≥75||p|
|Contrast Volume (ml)*||260(197.5-363)||270(200-364)||250(190-350)||0.306|
|Air Kerma Fluoroscopy Dose (Gray)*||3.4(2.0-5.3).||3.5(2.2-5.6)||3.2(1.8-5.4).||0.443|
|Procedure Time (min)*||126(81-184)||127(91-193)||130(85.8-196.8)||0.298|
|Technical Success (%)||91.1||90.7||85.7||0.054|
|Procedural Success (%)||90.6||88.8||82.8||0.008|
|In-hospital MACE (%)||0.9||3.0||5.1||0.002|
Dr. Iwnetu noted that the prevalence of stroke, prior coronary artery bypass graft surgery, hypertension, and moderately or severely calcified lesions all were higher among the older patients.
“The 5.1% MACE finding is interesting,” said Aris Karatasakis, MD, one of the study’s co-authors. He suggested the oldest patients may have had more severely calcified lesions. “It’s something to take into account when assessing the risks and benefits of CTO PCI for older patients.”
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