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Multicenter Study
. 2018 Jun 7;18(1):137.
doi: 10.1186/s12877-018-0818-z.

Improved short and long term survival associated with percutaneous coronary intervention in the elderly patients with acute coronary syndrome

Xiaojing Chen  1   2   3 , Salim Bary Barywani  4 , Runa Sigurjonsdottir  4 , Michael Fu  4
Affiliations
Multicenter Study

Improved short and long term survival associated with percutaneous coronary intervention in the elderly patients with acute coronary syndrome

Xiaojing Chen et al. BMC Geriatr. .

Abstract

Background: Percutaneous coronary intervention (PCI) are increasingly used in daily clinical practice in elderly patients with acute coronary syndrome (ACS) despite limited evidence. The purpose of this study was to assess the impact of PCI on short and long term survivals in a large cohort of elderly patients with ACS from a "real world".

Methods: We enrolled 491 patients aged ≥70 years admitted to our institution with ACS from 2006 to 2012. Effect of PCI on short and long term survival was evaluated in both overall and a propensity score-matched cohort.

Results: The mean age of the overall cohort is 83 ± 6 years. Among them, 285 were treated with PCI, whereas 206 were not. Patients treated with PCI were younger (82 ± 5 vs. 85 ± 6), more males (67% vs. 46%), with lower heart rate (77 ± 22 vs. 84 ± 21), higher eGFR (58 ± 20 vs. 47 ± 23), and less with heart failure (29% vs. 15%) (all p < 0.001). In both overall and propensity-matched population, improved survival was associated with PCI-treatment at 1 and 3 years (p < 0.001 for all comparisons). Furthermore, by using multivariate Cox proportional-hazards regression model following factors were identified as independent predictors of 3-year all-cause mortality: age (HR 1.08, 95% CI 1.00-1.16), heart rate (HR 1.02, 95% CI 1.01-1.03), eGFR (HR 3.07, 95% CI 1.63-5.77), malignancy (HR 2.03, 95% CI 1.27-4.57), prior CABG (HR 2.033, 95% CI 1.27-4.57), medication with statin (HR 0.40, 95% CI 0.19-0.86) in PCI group, whereas age (HR 1.08, 95% CI 1.03-1.13), heart rate (HR 1.01, 95% CI 1.01-1.02), hypertension (HR 1.87, 95% CI 1.01-3.49) and using of ACEI/ARB (HR 0.46, 95% CI 0.28-0.76) in non-PCI group.

Conclusions: In elderly ACS patients, PCI-treatment was associated with improved 1 and 3-year survival and PCI-treated patients had different prognostic profile compared to those without PCI treatment.

Keywords: Acute coronary syndrome; Elderly; Percutaneous coronary intervention; Short and long outcome.

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Conflict of interest statement

Ethics approval and consent to participate

This study protocol was approved by the Human Ethical Committee at University of Gothenburg. All study participants provided written informed consent.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Numbers of elderly patients treated or not treated with PCI according to chronological age
Fig. 2
Fig. 2
Propensity scores for treated with or without PCI in the unmatched and matched populations. Boxes represent median and interquartile range, vertical lines represent minimum and maximum
Fig. 3
Fig. 3
Comparison of survival of elderly patients treated with or without PCI after acute coronary syndrome. a: overall cohort; b: the matched cohort
See this image and copyright information in PMC

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