Abstract 2472: In-hospital Outcomes Following Percutaneous Revascularization In Very Elderly Patients
Objective: Using a propensity score matched cohort, we compared in-hospital outcomes of very elderly patients (age ≥85) with younger patients (age <85) undergoing PCI.
Methods: From 04/00 until 10/05, 10,821 PCI procedures were performed at the University Health Network in Toronto, Canada. Baseline clinical, angiographic, procedural, and in-hospital outcome variables were entered prospectively into our registry. The following variables were entered into a saturated logistic regression model to calculate the propensity score: creatinine clearance, BMI<25, female gender, CCS class, diabetes, hypercholesterolemia, recent MI, urgent PCI, left main disease, multi-vessel disease, thrombocytopenia (plts<150x109/L), ejection fraction<40%, type C lesions, and saphenous vein graft PCI. Of the 209 patients ≥85, 29 were excluded due to incomplete matching (13.9%). The remaining elderly patients (n=180) were matched at a 1:2 ratio with younger patients (n=360).
Results: Elderly patients had a mean age of 87.5±2.5 (range 85 to 97) vs. 71.4±10.1 years for the younger cohort. The clinical indication for PCI was not different between cohorts (elective PCI 22.9 vs. 24.4%; urgent PCI 63.9 vs. 64.2%; 8.9 vs. 7.8%; salvage PCI 4.4 vs. 3.6%). With variable matching, there was no significant difference between elderly and younger patients in length of hospitalization (3.1 vs. 2.2 d), in-hospital MACE (8.9 vs. 5.8%), post-procedural MI (3.9 vs. 3.3%), TVR (0 vs. 0.6%), access site complications (4.4 vs. 2.8%), renal failure (4.4 vs. 2.5%), or neurological events (0.6 vs. 0.3%) (p=NS). In-hospital mortality was increased in elderly patients (5 vs. 1.9%, p=0.048). Mortality rates by PCI indication between elderly and younger groups were: elective PCI 0.6 vs. 0%; urgent PCI 3.8 vs. 0.3%; primary PCI 0.6 vs. 0.8%; salvage PCI 0 vs. 0.8%.
Conclusions: After adjusting for important prognostic variables, elderly patients had no significant increase in early MACE or length of hospitalization. Although in-hospital mortality was significantly increased compared with younger patients, death rate was low. Decisions to proceed with PCI in very elderly patients should be based on prognostic variables. These patients should not be excluded from revascularization based on age alone.