Abstract 17170: Long-Term Outcome in Elderly Patients (=75 years) versus Younger Patients (<75 years) Undergoing PCI for Chronic Total Occlusion
OBJECTIVES: To assess the procedural success rate and the long-term clinical impact of percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) in elderly patients.
METHODS: A total of 1,343 consecutive patients underwent PCI for 1,432 CTO lesions between Jan 2004 and Jan 2012 at our center. Outcomes included procedural success and major adverse cardiac events (MACE) and its components, cardiac death, myocardial infarction and target vessel revascularization including coronary artery bypass graft surgery. Time-to-event analyses were performed using Kaplan–Meier statistics, and the log-rank statistic was used to test for differences between patients aged ≥75 and patients aged <75 years.
RESULTS: A total of 253 patients (19%) were aged ≥75 years. Compared to patients <75 years, elderly patient were more commonly female (20% vs. 11.8%, p<0.0001), had a higher background history of heart failure (6.3% vs. 3.6% p=0.04) and presented most commonly with left anterior descending coronary artery CTO (41.5% vs. 28.5%, p=0.001). Procedural success rates were similar in elderly patients compared with patients <75 years (74.9% vs. 72.7%, p = 0.48). Elderly patients with failed CTO PCI tended have a higher rate of hypertension (80.3% vs. 66.7%, p=0.02) and previous PCI (42.1 vs. 28.8, p 0.03). Median follow-up was 4.1 years (IQR: 2.4-6.5 years). MACE rates after successful versus failed PCI were 20.9% versus 29.8% in the elderly (p = 0.15) and 21.0 versus 24.1% in younger patients (p = 0.12). In elderly patients, this trend in reduction in MACE after successful PCI was driven by a significant reduction in cardiac mortality (Figure ). There was also a significant reduction in all-cause mortality (21.1% vs. 35.9%, p = 0.02) and no significant differences in the rate of MI (2.8% vs. 1.6%, p = 0.597).
CONCLUSIONS: PCI for CTO has similar success rate in the elderly (≥75 years) and is associated with a significant reduction in cardiac mortality when success is achieved.
- © 2013 by American Heart Association, Inc.