Abstract 3242: Elderly Patients with Major Bleeding or Need for Transfusion Complicating Percutaneous Coronary Intervention Have an Increased Risk of 30-Day and 1-Year Mortality
Background: Elderly patients have an increased risk of major bleeding and transfusion when undergoing percutaneous coronary intervention (PCI). Despite these risks, the effect of major bleeding and transfusion on mortality in the elderly is unknown. We evaluated the impact of major bleeding and transfusion on the risk of 30-day and 1-year mortality in elderly patients undergoing PCI.
Methods: We reviewed the Randomized Evaluation in PCI Linking Angiomax to Reduced Clinical Events (REPLACE)-2 Trial, which compared bivalirudin + provisional IIb/IIIa inhibitors (GPI) to heparin + planned GPI in patients undergoing elective or urgent PCI. Elderly patients were defined as > 75 years of age.
Results: Of 6002 patients evaluated, 806 (13.4%) were elderly. Elderly patients had an increased risk of blood transfusion (5.0% vs. 1.7%, p<0.0001) and an increased risk of major bleeding (6.7% vs. 2.7% p<0.0001) compared to younger patients. Among patients with major bleeding (n=195), the elderly had higher mortality rates at 30 days (13.0% vs. 2.2%, p<0.01) and one year (16.7% vs. 5.8%, p<0.02) compared to younger patients. Among transfused patients (n=126), the elderly had higher mortality rates at 30 days (15.0% vs. 2.3%, p<0.02) and one year (25.0% vs. 8.5%, p<0.02) compared to younger patients. Among elderly patients, those with major bleeding had higher 30-day and 1-year mortality rates compared to those without major bleeding (13.0% vs. 0.4%, p<0.0001; 16.7% vs. 4.5%, p=0.0001, respectively). Similarly, among elderly patients, transfusion was associated with higher mortality rates at 30 days and one year compared to non-transfused patients (15.0% vs. 0.5%; 25.0% vs. 4.2% respectively; all p<0.0001).
Conclusions: Elderly patients undergoing PCI have an increased risk of major bleeding and transfusion, which is associated with a significant increase in 30-day and 1-year mortality. Minimizing the risk of major bleeding and transfusion is essential in order to improve outcomes in elderly patients undergoing PCI.