Abstract 4732: Puncture Access Site Complications in Octogenerians in 56.980 Consecutive Cardiac Catheterizations: Is the Risk Clincally Acceptable?
Background: Due to the demographic change in Western societies elderly patients (>=80 years) are increasingly presenting for invasive cardiological procedures. However, there is still a wide-spread concern that these multimorbid patients are at a higher risk for complications during or immediately after the catheterization. In the present clinical study we therefore calculated the age-related relative risk for peripheral vascular complications for the age groups 80 years and older, 65–79 years and <65 years based on the prospective complication database of our institution.
Methods: All vascular access site complications were prospectively collected between 01/01/2003 and 31/12/2008 for a total total number of 56.980 invasive procedures using femoral arterial access. Patients were included as peripheral complication based on the Doppler ultrasound diagnosis of access site hemorrhage, AV-fistula, false aneurysm, or vascular occlusion.
Results: A total of 175 octogenerians (83.8±5.5 years; 110 female, 65 male) had an access site complication (3,0% of 5790 procedures). The access site complications included pseudoaneurysms (n=122, 69,7%), hemorrhages (n=15, 8,6%), AV-fistulas (n=21, 12%), vascular occlusions (n=15, 8,6%), arterial dissections (n=2, 1,1%), and others n=1 (0,6%). Of these 175 patients with complications n=46 (26,3%) presented with stable angina, n=34 (19,5%) with known stable CAD, n=15 (8,6%) with unstable angina, n=37 (21,1%) with NSTEMI, n=16 (9,1%) with STEMI, and n=27 (15,4%) with valvular heart disease. In the age group 65–79 years a total of 526 puncture access site complication occurred (1,75% of 29.996 procedures), for patients <65 years 201 complications were counted (0,95% of 21.194 procedures). As compared to patients 65–79 years and <65 years the risk of octogenarians to develop peripheral access site complications was increased 1.7-fold and 3.2-fold, respectively.
Conclusion: Although access site complications are more common in octogenerians the increase in relative risk is modest (1.7-fold and 3.2-fold increased risk compared to patients 65–79 years and <65 years). Cardiac catheterizations procedures can, therefore, be safely performed in octogenerians.