Predictors of long-term outcome of percutaneous coronary intervention in elderly patients with acute coronary syndrome – a retrospective analysis

Abstract

Degree Project, Programme in Medicine TITLE: Predictors of long-term outcome of percutaneous coronary intervention in elderly patients with acute coronary syndrome – a retrospective analysis

AUTHOR, YEAR: Maria Lindh, 2012 INSTITUTION, CITY, COUNTRY: Section of Cardiology, Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Gothenburg, Sweden

BACKGROUND: Elderly patients constitute the majority of patients with acute coronary syndrome. Nevertheless, due to a paucity of data, decision-making on the use of percutaneous coronary intervention in this patient group is mainly empirical. Old age is associated with higher risk of adverse outcome of PCI. It is however not well-known what other factors than age that are of prognostic significance. Likely, considering the heterogeneity of the patient group, there is a subgroup of elderly patients for which the prospects of gaining from intervention are greater than for others. By studying and evaluating factors that may be of prognostic significance this subgroup of elderly patients may be identified and so a more optimal use of PCI could be attained.

OBJECTIVE: To evaluate the prognosis of elderly patients undergoing PCI in the setting of ACS. More specifically, to retrospectively identify predictors of all-cause long-term mortality among patients ≥ 80 years, i.e. the “oldest” old.

METHODS: Data on 64 patients ≥80 years undergoing PCI with the indication ACS at the Sahlgrenska University Hospital in Gothenburg, Sweden, were retrospectively collected in a database. In order to identify predictors of long-term mortality multivariate regression analysis was performed. Kaplan-Meier curves were constructed to illustrate the relation between factors of prognostic significance and survival over time.

RESULTS: 4-year all-cause mortality in the current study population was about 40%. Age, heart rate, glomerular filtration rate and prior CABG were identified as independent predictors of long-term mortality.

CONCLUSIONS: In an elderly patient population patients with an age of >85 years, increased heart rate, renal insufficiency and prior CABG are at higher risk of adverse long-term outcome of PCI and so potentially have less to gain from intervention. However, further studies, in particular prospective ones, are needed to validate these results.