The aim of the study was to evaluate clinical outcomes of Octogenarian patients treated with ultrathinstents on left main or on coronary bifurcations, compared with younger patients.

Methods

All consecutive patients presenting a critical lesion of an unprotected left main (ULM) or a bifurcation and treated with very thin stents were included in the RAIN (veRy thin stents for patients with left mAIn or bifurcatioN in real life) registry and divided into octogenarians group (OG, 551 patients) and nonoctogenarians (NOGs, 2,453 patients). Major adverse cardiovascular event (MACE), a composite end point of all-cause death, nonfatal myocardial infarction (MI), target lesion revascularization (TLR), and stent thrombosis (ST), was the primary endpoint, while MACE components, cardiovascular (CV) death, and target vessel revascularization (TVR) were the secondary ones.

Results

Indication for PCI was acute coronary syndrome in 64.7% of the OG versus 53.1% of the NOG. Severe calcifications and a diffuse disease were significantly more in OG. After a follow-up of 15.2 ± 10.3 months, MACEs were higher in the OG than in the NOG patients (OG 19.1% vs. NOG 11.2%, p < .001), along with MI (OG 6% vs. NOG 3.4%, p = .002) and all-cause death (OG 14% vs. NOG 4.3%, p < .001). In contrast, no significant difference was detected in CV-death (OG 5.1% vs. NOG 4%, p = .871), TVR/TLR, or ST. At multivariate analysis, age was not an independent predictor of MACE (OR 1.02 CI 95% 0.76–1.38), while it was for all-cause death, along with diabetes, GFR < 60 ml/min, and ULM disease.

Discussion

Midterm outcomes of complex PCI in OG are similar to those of younger patients. However, due to the higher non-CV death rate, accurate patient selection is mandatory.

REFERENCES

1Over 27 million people aged 80 and over in the EU. Eurostat Web site. http://ec.europa.eu/eurostat/web/products-eurostat-news/-/EDN-20170930-1. Accessed June 24, 2018.
Google Scholar
2Wilson PW, D'Agostino RB, Levy D, Belanger AM, Silbershatz H, Kannel WB. Prediction of coronary heart disease using risk factor categories. Circulation. 1998; 97(18): 1837-1847.
10.1161/01.CIR.97.18.1837
CAS PubMed Web of Science® Google Scholar
3Grundy SM. Age as a risk factor: you are as old as your arteries. Am J Cardiol. 1999; 83(10): 1455-1457.
CAS PubMed Web of Science® Google Scholar
4Avezum A, Makdisse M, Spencer F, et al. Impact of age on management and outcome of acute coronary syndrome: observations from the global registry of acute coronary events (GRACE). Am Heart J. 2005; 149(1): 67-73.
10.1016/j.ahj.2004.06.003
PubMed Web of Science® Google Scholar
5Rothwell PM, Coull AJ, Silver LE, et al. Population-based study of event-rate, incidence, case fatality, and mortality for all acute vascular events in all arterial territories (Oxford vascular study). Lancet. 2005; 366(9499): 1773-1783.
10.1016/S0140-6736(05)67702-1
CAS PubMed Web of Science® Google Scholar
6Newby LK. Acute coronary syndromes in the elderly. J Cardiovasc Med. 2011; 12(3): 220-222.
10.2459/JCM.0b013e328343e9ce
Google Scholar
7Gale CP, Cattle BA, Woolston A, et al. Resolving inequalities in care? Reduced mortality in the elderly after acute coronary syndromes. The myocardial Ischaemia National Audit Project 2003-2010. Eur Heart J. 2012; 33(5): 630-639.
10.1093/eurheartj/ehr381
PubMed Web of Science® Google Scholar
8Sanchis J, Bonanad C, Ruiz V, et al. Frailty and other geriatric conditions for risk stratification of older patients with acute coronary syndrome. Am Heart J. 2014; 168(5): 784-791.
10.1016/j.ahj.2014.07.022
PubMed Web of Science® Google Scholar
9Smith LG, Herlitz J, Karlsson T, Berger AK, Luepker RV. International comparison of treatment and long-term outcomes for acute myocardial infarction in the elderly: Minneapolis/St. Paul, MN, USA and Goteborg, Sweden. Eur Heart J. 2013; 34(41): 3191-3197.
10.1093/eurheartj/eht196
PubMed Web of Science® Google Scholar
10Amann U, Kirchberger I, Heier M, et al. Predictors of non-invasive therapy and 28-day-case fatality in elderly compared to younger patients with acute myocardial infarction: an observational study from the MONICA/KORA myocardial infarction registry. BMC Cardiovasc Disord. 2016; 16: 151.
10.1186/s12872-016-0322-3
PubMed Web of Science® Google Scholar
11DeGeare VS, Stone GW, Grines L, et al. Angiographic and clinical characteristics associated with increased in-hospital mortality in elderly patients with acute myocardial infarction undergoing percutaneous intervention (a pooled analysis of the primary angioplasty in myocardial infarction trials). Am J Cardiol. 2000; 86(1): 30-34.
CAS PubMed Web of Science® Google Scholar
12Antonsen L, Jensen LO, Terkelsen CJ, et al. Outcomes after primary percutaneous coronary intervention in octogenarians and nonagenarians with ST-segment elevation myocardial infarction: from the Western Denmark heart registry. Catheter Cardiovasc Interv. 2013; 81(6): 912-919.
10.1002/ccd.24591
PubMed Web of Science® Google Scholar
13Batchelor WB, Anstrom KJ, Muhlbaier LH, et al. Contemporary outcome trends in the elderly undergoing percutaneous coronary interventions: results in 7,472 octogenarians. National Cardiovascular Network Collaboration. J Am Coll Cardiol. 2000; 36(3): 723-730.
10.1016/S0735-1097(00)00777-4
CAS PubMed Web of Science® Google Scholar
14Singh M, Mathew V, Garratt KN, et al. Effect of age on the outcome of angioplasty for acute myocardial infarction among patients treated at the Mayo Clinic. Am J Med. 2000; 108(3): 187-192.
10.1016/S0002-9343(99)00429-5
CAS PubMed Web of Science® Google Scholar
15Vandecasteele EH, De Buyzere M, Gevaert S, et al. Reperfusion therapy and mortality in octogenarian STEMI patients: results from the Belgian STEMI registry. Clin Res Cardiol. 2013; 102(11): 837-845.
10.1007/s00392-013-0600-3
PubMed Web of Science® Google Scholar
16Somma KA, Bhatt DL, Fonarow GC, et al. Guideline adherence after ST-segment elevation versus non-ST segment elevation myocardial infarction. Circ Cardiovasc Qual Outcomes. 2012; 5(5): 654-661.
10.1161/CIRCOUTCOMES.111.963959
PubMed Web of Science® Google Scholar
17Reinius P, Mellbin L, Holzmann MJ, Siddiqui AJ. Percutaneous coronary intervention versus conservative treatment for non ST-segment elevation myocardial infarction in patients above 80 years of age. Int J Cardiol. 2018; 267: 57-61.
10.1016/j.ijcard.2018.05.078
PubMed Web of Science® Google Scholar
18Tegn N, Abdelnoor M, Aaberge L, et al. Invasive versus conservative strategy in patients aged 80 years or older with non-ST-elevation myocardial infarction or unstable angina pectoris (after eighty study): an open-label randomised controlled trial. Lancet. 2016; 387(10023): 1057-1065.
10.1016/S0140-6736(15)01166-6
PubMed Web of Science® Google Scholar
19 TIME Investigators. Trial of invasive versus medical therapy in elderly patients with chronic symptomatic coronary-artery disease (TIME): a randomised trial. Lancet. 2001; 358(9286): 951-957.
10.1016/S0140-6736(01)06100-1
PubMed Web of Science® Google Scholar
20Fox KAA, Clayton TC, Damman P, et al. Long-term outcome of a routine versus selective invasive strategy in patients with non-ST-segment elevation acute coronary syndrome a meta-analysis of individual patient data. J Am Coll Cardiol. 2010; 55(22): 2435-2445.
10.1016/j.jacc.2010.03.007
PubMed Web of Science® Google Scholar
21Ibánez B, James S, Agewall S, et al. 2017 ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Rev Espanola Cardiol. 2017; 70(12): 1082.
PubMed Web of Science® Google Scholar
22ClinicalTrials.gov Database. Very thin stents for patients with left main or bifurcation in real life: the RAIN a multicenter study. https://clinicaltrials.gov/ct2/show/NCT03544294. October 21, 2018.
Google Scholar
23Miura T, Miyashita Y, Motoki H, et al. In-hospital clinical outcomes of elderly patients (≥80 years) undergoing percutaneous coronary intervention. Circ J. 2014; 78(5): 1097-1103.
10.1253/circj.CJ-14-0129
PubMed Web of Science® Google Scholar
24Nicolini F, Contini GA, Fortuna D, et al. Coronary artery surgery versus percutaneous coronary intervention in octogenarians: long-term results. Ann Thorac Surg. 2015; 99(2): 567-574.
10.1016/j.athoracsur.2014.09.019
PubMed Web of Science® Google Scholar
25Conrotto F, Scacciatella P, D'Ascenzo F, et al. Long-term outcomes of percutaneous coronary interventions or coronary artery bypass grafting for left main coronary artery disease in octogenarians (from a drug-eluting stent for left main artery registry substudy). Am J Cardiol. 2014; 113(12): 2007-2012.
10.1016/j.amjcard.2014.03.044
PubMed Web of Science® Google Scholar
26Anderson HV, Cannon CP, Stone PH, et al. One-year results of the thrombolysis in myocardial infarction (TIMI) IIIB clinical trial. A randomized comparison of tissue-type plasminogen activator versus placebo and early invasive versus early conservative strategies in unstable angina and non-Q wave myocardial infarction. J Am Coll Cardiol. 1995; 26(7): 1643-1650.
10.1016/0735-1097(95)00404-1
CAS PubMed Web of Science® Google Scholar
27Wallentin L, Swahn E. Long-term low-molecular-mass heparin in unstable coronary-artery disease: FRISC II prospective randomised multicentre study FRagmin and fast revascularisation during instability in coronary artery disease investigators. Lancet. 1999; 354(9180): 701-707.
10.1016/S0140-6736(99)07350-X
CAS PubMed Web of Science® Google Scholar
28Lagerqvist B, Husted S, Kontny F, et al. A long-term perspective on the protective effects of an early invasive strategy in unstable coronary artery disease: two-year follow-up of the FRISC-II invasive study. J Am Coll Cardiol. 2002; 40(11): 1902-1914.
10.1016/S0735-1097(02)02572-X
PubMed Web of Science® Google Scholar
29Bach RG, Cannon CP, Weintraub WS, et al. The effect of routine, early invasive management on outcome for elderly patients with non-ST-segment elevation acute coronary syndromes. Ann Intern Med. 2004; 141(3): 186-195.
10.7326/0003-4819-141-3-200408030-00007
PubMed Web of Science® Google Scholar
30Dziewierz A, Siudak Z, Rakowski T, Dubiel JS, Dudek D. Age-related differences in treatment strategies and clinical outcomes in unselected cohort of patients with ST-segment elevation myocardial infarction transferred for primary angioplasty. J Thromb Thrombolysis. 2012; 34(2): 214-221.
10.1007/s11239-012-0713-y
PubMed Web of Science® Google Scholar
31Bueno H, Betriu A, Heras M, et al. Primary angioplasty vs. fibrinolysis in very old patients with acute myocardial infarction: TRIANA (TRatamiento del Infarto Agudo de miocardio eN Ancianos) randomized trial and pooled analysis with previous studies. Eur Heart J. 2011; 32(1): 51-60.
10.1093/eurheartj/ehq375
PubMed Web of Science® Google Scholar
32Stone GW, Grines CL, Browne KF, et al. Predictors of in-hospital and 6-month outcome after acute myocardial infarction in the reperfusion era: the primary angioplasty in myocardial infarction (PAMI) trail. J Am Coll Cardiol. 1995; 25(2): 370-377.
10.1016/0735-1097(94)00367-Y
CAS PubMed Web of Science® Google Scholar
33Brieger D, Eagle KA, Goodman SG, et al. Acute coronary syndromes without chest pain, an underdiagnosed and undertreated high-risk group: insights from the global registry of acute coronary events. Chest. 2004; 126(2): 461-469.
10.1378/chest.126.2.461
PubMed Web of Science® Google Scholar
34O'Gara PT, Kushner FG, Ascheim DD, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines. J Am Coll Cardiol. 2013; 61(4): 78-140.
10.1016/j.jacc.2012.11.019
PubMed Web of Science® Google Scholar
35Topaz G, Finkelstein A, Flint N, et al. Comparison of 30-day and long-term outcomes and hospital complications among patients aged <75 versus ≥75 years with ST-elevation myocardial infarction undergoing percutaneous coronary intervention. Am J Cardiol. 2017; 119(12): 1897-1901.
10.1016/j.amjcard.2017.03.014
PubMed Web of Science® Google Scholar
36Lopes RD, Gharacholou SM, Holmes DN, et al. Cumulative incidence of death and rehospitalization among the elderly in the first year after NSTEMI. Am J Med. 2015; 128(6): 582-590.
10.1016/j.amjmed.2014.12.032
PubMed Web of Science® Google Scholar
37Ekerstad N, Swahn E, Janzon M, et al. Frailty is independently associated with 1-year mortality for elderly patients with non-ST-segment elevation myocardial infarction. Eur J Prev Cardiol. 2014; 21(10): 1216-1224.
10.1177/2047487313490257
PubMed Web of Science® Google Scholar
38Matsuzawa Y, Konishi M, Akiyama E, et al. Association between gait speed as a measure of frailty and risk of cardiovascular events after myocardial infarction. J Am Coll Cardiol. 2013; 61(19): 1964-1972.
10.1016/j.jacc.2013.02.020
PubMed Web of Science® Google Scholar
39Gharacholou SM, Roger VL, Lennon RJ, et al. Comparison of frail patients versus nonfrail patients ≥65 years of age undergoing percutaneous coronary intervention. Am J Cardiol. 2012; 109(11): 1569-1575.
10.1016/j.amjcard.2012.01.384
PubMed Web of Science® Google Scholar
40Singh M, Rihal CS, Lennon RJ, Spertus JA, Nair KS, Roger VL. Influence of frailty and health status on outcomes in patients with coronary disease undergoing percutaneous revascularization. Circ Cardiovasc Qual Outcomes. 2011; 4(5): 496-502.
10.1161/CIRCOUTCOMES.111.961375
PubMed Web of Science® Google Scholar
41Di Bari M, Balzi D, Fracchia S, et al. Decreased usage and increased effectiveness of percutaneous coronary intervention in complex older patients with acute coronary syndromes. Heart. 2014; 100(19): 1537-1542.
10.1136/heartjnl-2013-305445
PubMed Web of Science® Google Scholar
42Rowe R, Iqbal J, Murali-Krishnan R, et al. Role of frailty assessment in patients undergoing cardiac interventions. Open Heart. 2014; 1(1):e000033.
10.1136/openhrt-2013-000033
PubMed Google Scholar
43Moretti C, Quadri G, D'Ascenzo F, et al. THE STORM (acute coronary syndrome in patients end of life and risk assesment) study. Emerg Med J. 2016; 33(1): 10-16.
10.1136/emermed-2014-204114
PubMed Web of Science® Google Scholar
44Reinecke H, Trey T, Matzkies F, Fobker M, Breithardt G, Schaefer RM. Grade of chronic renal failure, and acute and long-term outcome after percutaneous coronary interventions. Kidney Int. 2003; 63(2): 696-701.
10.1046/j.1523-1755.2003.00784.x
PubMed Web of Science® Google Scholar
45Lin M-J, Lee J, Chen C-Y, Huang C-C, Wu H-P. Chronic kidney disease and diabetes associated with long-term outcomes in patients receiving percutaneous coronary intervention. BMC Cardiovasc Disord. 2017; 17: 242.
10.1186/s12872-017-0673-4
PubMed Web of Science® Google Scholar
46Hammoud T, Tanguay JF, Bourassa MG. Management of coronary artery disease: therapeutic options in patients with diabetes. J Am Coll Cardiol. 2000; 36(2): 355-365.
10.1016/S0735-1097(00)00732-4
CAS PubMed Web of Science® Google Scholar
47Tehrani S, Laing C, Yellon DM, Hausenloy DJ. Contrast-induced acute kidney injury following PCI. Eur J Clin Invest. 2013; 43(5): 483-490.
10.1111/eci.12061
CAS PubMed Web of Science® Google Scholar
48Neumann F-J, Sousa-Uva M, Ahlsson A, et al. ESC/EACTS guidelines on myocardial revascularization. Eur Heart J. 2018; 40(2019): 87-165.
Google Scholar
49Amsterdam EA, Wenger NK, Brindis RG, et al. 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: executive summary: a report of the American College of Cardiology/American Heart Association task force on practice guidelines. J Am Coll Cardiol. 2014; 130(25): 2354-2394.
Google Scholar
50Hamm CW, Bassand J-P, Agewall S, et al. ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: the task force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2011; 32(23): 2999-3054.
10.1093/eurheartj/ehr236
PubMed Web of Science® Google Scholar

Citing Literature

Volume97, Issue5

April 1, 2021

Pages 755-763

SCAI Member Sign in

Percutaneous coronary intervention of unprotected left main and bifurcation in octogenarians: Subanalysis from RAIN (veRy thin stents for patients with left mAIn or bifurcatioN in real life)

Abstract

Objective

Methods

Results

Discussion

REFERENCES

Citing Literature

References

Information

About Wiley Online Library

Help & Support

Opportunities

Connect with Wiley

Percutaneous coronary intervention of unprotected left main and bifurcation in octogenarians: Subanalysis from RAIN (veRy thin stents for patients with left mAIn or bifurcatioN in real life)

Abstract

Objective

Methods

Results

Discussion

REFERENCES

Citing Literature

References

Related

Information