Outcome in octogenarian patients with lower extremity artery disease after endovascular revascularisation: a retrospective single-centre cohort study using in-patient data
Holger Reinecke,
Christiane Engelbertz,
Nasser M Malyar,
Antonia Lakomek,
Jeanette Köppe,
Henrike Barenbrock,
Kristina Volkery,
Jannik Feld,
Lena Makowski,
Eva Freisinger
Affiliations
Holger Reinecke
3 Division of Vascular Medicine, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany
Christiane Engelbertz
1 Dept. of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Cardiol, Muenster, Germany
Department of Cardiology I—Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Muenster, Nordrhein-Westfalen, Germany
Jeanette Köppe
Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Nordrhein-Westfalen, Germany
Henrike Barenbrock
Department of Cardiology I—Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Muenster, Nordrhein-Westfalen, Germany
Kristina Volkery
Department of Cardiology I—Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Muenster, Nordrhein-Westfalen, Germany
Jannik Feld
Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Nordrhein-Westfalen, Germany
Lena Makowski
Department of Cardiology I—Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Muenster, Nordrhein-Westfalen, Germany
Eva Freisinger
Department of Cardiology I—Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Muenster, Nordrhein-Westfalen, Germany
Objectives To investigate the clinical benefit of endovascular revascularisation (EVR) in octogenarian (aged ≥80 years) patients with lower extremity artery disease (LEAD).Design Retrospective single-centre study.Setting University hospital with a specialised centre for vascular medicine.Participants 681 LEAD patients undergoing EVR between 2010 and 2016 were stratified by age.Main outcome measure Technical success, complications and mortality.Results The cohort comprised 172 (25.3%) octogenarian and 509 (74.7%) non-octogenarian patients. Despite higher LEAD stages and complexity of EVR in octogenarians, primary technical success rate (79% octogenarians vs 86% non-octogenarians, p=0.006) and 1-year survival (87% vs 96%, p<0.001) were overall on high levels. Especially for the octogenarians, 1-year survival depends on the presence of chronic limb-threatening ischaemia (CLTI) (octogenarians: non-CLTI 98%; CLTI 79% p<0.001 vs non-octogenarians: non-CLTI 99%; CLTI 91%, p<0.001). In octogenarians, female sex (HR 0.45; 95% CI (0.24 to 0.86); p=0.015), the intake of statins (HR 0.34; 95% CI 0.19 to 0.65; p=0.001) and platelet aggregation inhibitors (HR 0.10; 95% CI 0.02 to 0.45; p=0.003) were independently associated with improved survival after EVR.Conclusion EVR can be performed safely and with sustained clinical benefit also in octogenarian patients with LEAD. After-care including medical adherence is of particular importance to improve long-term survival.
