Yazji, K, Abdul, F, Elangovan, S, Ossei-Gerning, N, Choudhury, A, Cockburn, J, Anderson, R, Mamas, M ORCID: https://orcid.org/0000-0001-9241-8890 and Kinnaird, T (2016) Comparison of the Effects of Incomplete Revascularization on 12-month Mortality in Patients <80 compared to ≥80 Years of Age Undergoing Percutaneous Coronary Intervention. American Journal of Cardiology, 118 (5). pp. 1164-1170.

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Abstract

Although randomized trial data suggest that complete revascularization improves outcomes after percutaneous coronary intervention (PCI), the impact of differing revascularization strategies in octogenarians is not well defined. We performed a retrospective analysis, which was conducted of 9,628 consecutive patients who underwent PCI at a large UK center. Octogenarians were more likely to have significant co-morbidity, a higher Mehran bleed risk score (24.5 ± 6.8 vs 13.3 ± 7.4, p <0.0001), and more complex disease (baseline SYNTAX score 18.7 ± 11.0 vs 13.1 ± 8.9, p = 0.002) than younger patients. During PCI, octogenarians were more likely to undergo left main or proximal LAD intervention, but despite this, significantly less likely to receive drug-eluting stents (66.5% vs 80.1%, p <0.001). Postprocedurally, octogenarians had greater residual disease burden (residual SYNTAX score 10.1 ± 8.7 vs 1.6 ± 3.3, p <0.0001). At 12 months, adverse outcomes (definite stent thrombosis 3.3% vs 1.1%, p <0.001, clinically driven in-stent restenosis PCI 3.7% vs 2.6%, p = 0.005, and 12-month mortality 12.8% vs 4.2%, p <0.0001) were all more frequent in octogenarians. Although age, shock, diabetes, and BMS use were independently predictive of increased 12-month mortality, incomplete revascularization was not. In conclusion, octogenarians are a complex group to treat balancing high-risk bleeding profile and complex coronary disease. However, in multivariate analysis, incomplete revascularization was not independently predictive of adverse outcomes. These data support a conservative target lesion—only DES-driven revascularization strategy.

Item Type: Article
Additional Information: This is the accepted author manuscript (AAM). The final published version (version of record) is available online via Elsevier at http://doi.org/10.1016/j.amjcard.2016.07.031 - please refer to any applicable terms of use of the publisher.
Uncontrolled Keywords: elderly; octogenarian; bare-metal stent; drug-eluting stent; revascularisation
Subjects: R Medicine > R Medicine (General)
Divisions: Faculty of Medicine and Health Sciences > Institute for Science and Technology in Medicine
Depositing User: Symplectic
Date Deposited: 27 Jul 2016 10:10
Last Modified: 08 Apr 2019 09:30
URI: http://eprints.keele.ac.uk/id/eprint/2059

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