Abstract 16965: Combination of Angiographic and Clinical Characteristics for the Prediction of Clinical Outcomes in Elderly Patients Undergoing Multivessel PCI
Background: Risk stratification is essential for the clinical decision-making process in elderly patients undergoing multi-vessel (MV) revascularization. The aim of this study is to assess the prognostic value of angiographic versus clinical characteristics for the prediction of major adverse cardiac and cerebrovascular events (MACCE: all-cause mortality, non-fatal myocardial infarction, stroke, and target lesion revascularization).
Methods and Results: In 328 elderly patients ≥ 70 years, who were followed up for a first MACCE after MV-PCI, SYNTAX score and EuroSCORE have been calculated for a combined risk model. 328 patients (age range 70-95) were followed up for 2.7 ± 1.5 years (Follow-up rate: 97.9%). 42.7% (140/328) of the patients presented with acute coronary syndrome (ACS). At 3 years after MV-PCI, a first MACCE occurred in 50.0% (164/328) of the patients. Baseline SYNTAX score (32.9 ± 14.7 vs. 27.8 ± 13.3; P=0.001) and logistic EuroSCORE (6.3 (3.8/13.1) vs. 9.0 (5.8/14.4); P=0.001) were significantly increased in patients with MACCE during follow-up. To improve the predictive ability of both scores, we developed a combined risk score model with ROC curve validated cut-off values for EuroSCORE (>5%) and SYNTAX Score (>25). Thus, we were able to stratify the patients in a low, medium, and a high risk group with a 3-year MACCE rate of 23.1%, 47.2%, and 61.2%, respectively (P<0.001). High risk patients had a 3.5-fold higher risk for MACCE after 3 years (HR 3.5, 95% CI: 1.9-6.5; P<0.001).
Conclusions: For adequate risk assessment in elderly patients undergoing MV-PCI, consideration of both - comorbidities and coronary anatomic complexity - is essential. A combination of angiographic and clinical risk scores improves the prognostic value and is superior to stand-alone scores in elderly patients.
- Coronary artery disease
- Percutaneous coronary intervention
- Myocardial revascularization
- Risk factors
- © 2012 by American Heart Association, Inc.