Author + information
- Kashish Goel1,
- Tanush Gupta2,
- Dhaval Kolte3,
- Sahil Khera4,
- Deepak Bhatt5,
- Rajiv Gulati1,
- Malcolm Bell1,
- Chet Rihal1 and
- David Holmes Jr.1
- 1Mayo Clinic, Rochester, Minnesota, United States
- 2Albert Einstein College of Medicine/ Montefiore Medical Center, Bronx, New York, United States
- 3Brown University, Providence, Rhode Island, United States
- 4Westchester Medical Center, Valhalla, New York, United States
- 5Brigham and Women's Hospital, Boston, Massachusetts, United States
With increasing life expectancy, the number of patients > 90 years requiring percutaneous coronary intervention (PCI) in the United States (U.S.) is increasing. However, the outcomes data is limited as the largest published meta-analysis PCI outcomes in nonagenarians included only 570 patients. The objective of this study is to assess the temporal trends and outcomes of PCI in nonagenarians in the U.S.
The National Inpatient Sample (NIS) database was used to identify all patients aged >90 years who underwent PCI in the U.S. from Jan 1, 2003 to Dec 31, 2014. Weighted sampling was performed for all inpatient hospitalizations. Multivariable logisitc and linear regression models were used to assess the trends in in-hospital outcomes after PCI.
Patients ≥ 90 years (n=69, 271) constituted 0.9% of the total PCIs performed during the study period. The proportion of nonagenarians undergoing PCI increased significantly from 0.6% (n=9,404) in 2003-04 to 1.4% (n=13,265) in 2013-14 (ptrend<0.001). The proportion of PCI’s performed for STEMI (from 23.1% to 30.9%) and NSTEACS (from 49.6% to 52.6%) increased whereas, that for stable ischemic heart disease (from 27.3% to 16.5%) decreased (ptrend<0.001 for all). In nonagenarians with STEMI and NSTEACS, the incidence of cardiogenic shock increased from 3.8% in 2003-04 to 9.3% in 2013-14 (ptrend< 0.001). Overall in-hospital mortality after PCI was 6.8%. We noted a significant increase in the rate of in-hospital mortality after PCI in nonagenarians from 2003-04 (5.1%) to 2013-14 (8.2%; ptrend<0.001), which persisted after multivariable adjustment for demographics, co-morbidities, hospital characteristics, and indication for PCI (adjusted OR, 1.10; 95% CI, 1.08-1.12). Risk-adjusted incidence of ischemic stroke (0.4% to 1.5%; ptrend<0.001) and major bleeding (2.7% to 3.4%; ptrend<0.001) increased and that of vascular complications decreased (1.3% to 0.9%; ptrend<0.001). Mean length of stay decreased slightly during the study period (from 5.1 days to 4.8 days; ptrend<0.001).
In the largest study to-date evaluating the utilization and outcomes of PCI in ≈ 70,000 nonagenarians, we found that number of PCIs increased from 2003-04 to 2013-14 primarily related to acute coronary syndromes. In-hospital mortality, major bleeding, and ischemic stroke increased whereas, vascular complications decreased during the study period. In hospital mortality was 6.8% and the incidence of major complications <5%. These data suggest that PCI is a viable therapeutic option for nonagenarians, and call for better risk stratification and mitigation of complications.
CORONARY: PCI Outcomes