Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease (Mar 2019)

Comparison of Outcomes After Percutaneous Coronary Intervention in Elderly Patients, Including 10 628 Nonagenarians: Insights From a Japanese Nationwide Registry (J‐PCI Registry)

  • Yohei Numasawa,
  • Taku Inohara,
  • Hideki Ishii,
  • Kyohei Yamaji,
  • Shun Kohsaka,
  • Mitsuaki Sawano,
  • Masaki Kodaira,
  • Shiro Uemura,
  • Kazushige Kadota,
  • Tetsuya Amano,
  • Masato Nakamura

DOI
https://doi.org/10.1161/JAHA.118.011017
Journal volume & issue
Vol. 8, no. 5

Abstract

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Background Scarce data exist about the outcomes after percutaneous coronary intervention (PCI) in old patients. This study sought to provide an overview of PCI in elderly patients, especially nonagenarians, in a Japanese large prospective nationwide registry. Methods and Results We analyzed 562 640 patients undergoing PCI (≥60 years of age) from 1018 Japanese hospitals between 2014 and 2016 in the J‐PCI (Japanese percutaneous coronary intervention) registry. Among them, 10 628 patients (1.9%), including 6780 (1.2%) with acute coronary syndrome (ACS) and 3848 (0.7%) with stable coronary artery disease, were ≥90 years of age. We investigated differences in characteristics and in‐hospital outcomes among sexagenarians, septuagenarians, octogenarians, and nonagenarians. Older patients were more frequently women and had a greater frequency of heart failure and chronic kidney disease than younger patients. In addition, older patients had a higher rate of in‐hospital mortality, cardiac tamponade, cardiogenic shock after PCI, and bleeding complications requiring blood transfusion. Nonagenarians had the highest risk of in‐hospital mortality (odds ratio, 3.60; 95% CI, 3.10–4.18 in ACS; odds ratio, 6.24; 95% CI, 3.82–10.20 in non‐ACS) and bleeding complications (odds ratio, 1.79; 95% CI, 1.35–2.36 in ACS; odds ratio, 2.70; 95% CI, 1.68–4.35 in non‐ACS) when referenced to sexagenarians. More important, transradial intervention was an inverse independent predictor of both in‐hospital mortality and bleeding complications. Conclusions Older patients, especially nonagenarians, carried a greater risk of in‐hospital death and bleeding compared with younger patients after PCI. Transradial intervention might contribute to risk reduction for periprocedural complications in elderly patients undergoing PCI.

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