Percutaneous treatment of the left main coronary artery in older adults. Impact of frailty on mid-term results

Abstract

ABSTRACT Introduction and objectives: In elderly and frail patients, there is limited evidence on the therapeutic management of left main coronary artery (LM) disease. The objective of this study was to evaluate mid-term clinical outcomes in older adults undergoing percutaneous coronary intervention (PCI) of LM. Methods: We conducted a retrospective study including all older patients (≥ 75 years) undergoing LM-PCI at a high-volume center between 2017 and 2021. The primary endpoint was a composite of major adverse cardiovascular events (MACE). Patients were grouped according to the presence of frailty based on the FRAIL scale. Inverse probability of treatment weighting was used to account for clinical differences between the 2 groups. Results: A total of 140 patients were included in the study (median age 80 [78-84]; 36% women). Of them, 49% met the criteria for frailty. After a median follow-up of 19 [5-35] months, 40 MACE (29%) were recorded. The all-cause death rate was 32%. There were no differences in the risk of MACE between frailty groups, but patients with frailty had an increased risk of all-cause mortality (HRadj, 1.95 [1.02-3.75]; P = .046). Conclusions: LM-PCI in older adults with multiple associated comorbidities could be considered a feasible option in this special population. The rate of MACE at follow-up was acceptable. Frailty was associated with a worse prognosis in terms of all-cause mortality at follow-up.

Keywords

• Coronary artery disease
• Left main coronary artery
• Percutaneous coronary intervention
• Elderly
• Frailty