Author + information
- Lindsay Lee Anderson,
- Dadi (David) Dai,
- Amy Leigh Miller,
- Matthew Roe,
- John Messenger and
- Tracy Wang
Ischemia is an important consideration in syncope evaluation, especially among older adults. Yet evidence supporting the benefit of PCI among syncope patients found to have obstructive CAD is sparse.
We studied patients > age 65 undergoing cardiac catheterization for syncope in the CathPCI Registry® (2005 – 2009) with ≥70% lesion in ≥1 coronary artery, excluding STEMI, cardiogenic shock, left main ≥50%, and subsequent CABG. Using linked Medicare data (median follow-up 640 days), we compared long-term risks of MACE (death, MI or stroke) and late revascularization with inverse probability weighted risk adjustment between patients who did and did not undergo PCI.
Among 7338 syncope patients with obstructive CAD (median age 77), 3196 (43%) patients underwent PCI. Syncope patients who underwent PCI were more likely to have concurrent NSTEMI (21% vs. 16%, p<0.001), preceding non-invasive testing (81% vs. 65%, p<0.001), and single vessel CAD (45% vs. 29%, p<0.001). There was no significant difference in MACE between patients treated with and without PCI (unadjusted 30% vs. 36%. adjusted HR 0.98, 95% CI 0.89 – 1.06), but there was a higher risk of late revascularization in PCI-treated patients (unadjusted 14% vs. 9%, adjusted HR1.47, 95% CI 1.27 – 1.71, Figure).
Older patients undergoing PCI after syncope had similar long term cardiovascular outcomes compared with patients treated with initial medical therapy; but were associated with higher risks of late revascularization.
Poster Sessions, Expo North
Saturday, March 09, 2013, 3:45 p.m.-4:30 p.m.
Session Title: AMI and PCI
Abstract Category: 28. Quality of Care and Outcomes Assessment
Presentation Number: 1158-105
- 2013 American College of Cardiology Foundation