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.”
The Impella 2.5 system is a temporary (<6 hours) ventricular support device indicated for use during high risk percutaneous coronary interventions (PCI) performed in elective or urgent, hemodynamically stable patients with severe coronary artery disease and depressed left ventricular ejection fraction, when a heart team, including a cardiac surgeon, has determined high risk PCI is the appropriate therapeutic option. Use of the Impella 2.5 in these patients may prevent hemodynamic instability which can result from repeat episodes of reversible myocardial ischemia that occur during planned temporary coronary occlusions and may reduce peri- and post-procedural adverse events.
Protected PCI and use of the Impella 2.5 is not right for every patient. Patients may not be able to be treated with Impella if they have certain pre-existing conditions, which a cardiologist can determine, such as: severe narrowing of the heart valve, severe peripheral artery disease, clots in blood vessels, or a replacement heart valve or certain heart valve deficiencies. Additionally, use of Impella has been associated with risks, including, but not limited to valvular and vascular injury, bleeding, and limb ischemia in certain patients. Learn more about the Impella devices’ approved indications for use, as well as important safety and risk information at www.protectedpci.com/indications-use-safety-information/.