Abstract 4297: The Impact of Vascular Complications and Advanced Age on Outcomes Following Percutaneous Coronary Intervention
Background Elderly patients undergoing percutaneous coronary intervention (PCI) are at higher risk for both major vascular access site complications (MAC) and mortality. However, whether MAC independently elevates the risk for mortality in the elderly is unknown. Therefore, in the National Heart and Lung Blood Institute (NHLBI) Dynamic Registry, we evaluated the effect of age and MAC on outcome following PCI.
Methods From the NHLBI-sponsored Dynamic Registry, 10,920 PCI-treated patients were enrolled during five time-points (July 1997- August 2006). MAC was defined as vascular bleeding requiring transfusion, retroperitoneal haemorrhage, pseudo aneurysm, arterio-venous fistula, femoral thrombus or major hematoma. Differences and outcomes of MAC were compared among three age groups: younger (<65 yrs, n=5851); older (65–79, n=4202); elderly (≥80, n=867).
Results Femoral access was used in the majority of cases (96.6%). The incidence of MAC increased with each age group (3.0%, 5.5%, 8.3%, ptrend<0.001). As well, rates of in-hospital death (0.6%, 1.8%, 2.8%, ptrend<0.001), myocardial infarction (MI) (1.9%, 2.7%, 3.7%, ptrend<0.001), and death/MI (2.4%, 4.4%, 6.0%, ptrend<0.001) increased with each age group. After adjustment for multiple covariates including sex, the occurrence of MAC markedly increased the risk of serious in-hospital clinical outcomes in older and elderly patients (table⇓).
Conclusion In a contemporary cohort of patients undergoing PCI, MAC occurs more frequently in the aged. Additionally, adverse in-hospital outcomes are seen in older and elderly patients with MAC. Thus, particular focus on vascular complications in aging patients is essential to reduce cardiovascular events.