Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Feb 7;12(3):e027915.
doi: 10.1161/JAHA.122.027915. Epub 2023 Jan 31.

Health Status Outcomes in Older Adults Undergoing Chronic Total Occlusion Percutaneous Coronary Intervention

Dan D Nguyen  1   2 , Kensey L Gosch  1 , Rayan El-Zein  1   2 , Paul S Chan  1   2 , William L Lombardi  3 , Dimitri Karmpaliotis  4 , John A Spertus  1   2 , R Michael Wyman  5 , William J Nicholson  6 , Jeffrey W Moses  7   8 , J Aaron Grantham  1   2 , Adam C Salisbury  1   2 ; OPEN‐CTO Study Group *
Collaborators, Affiliations

Health Status Outcomes in Older Adults Undergoing Chronic Total Occlusion Percutaneous Coronary Intervention

Dan D Nguyen et al. J Am Heart Assoc. .

Abstract

Background Although chronic total occlusions (CTOs) are common in older adults, they are less likely to be offered CTO percutaneous coronary intervention for angina relief than younger adults. The health status impact of CTO percutaneous coronary intervention in adults aged ≥75 years has not been studied. We sought to compare technical success rates and angina-related health status outcomes at 12 months between adults aged ≥75 and <75 years in the OPEN-CTO (Outcomes, Patient Health Status, and Efficiency in Chronic Total Occlusion) registry. Methods and Results Angina-related health status was assessed with the Seattle Angina Questionnaire (score range 0-100, higher scores denote less angina). Technical success rates were compared using hierarchical modified Poisson regression, and 12-month health status was compared using hierarchical multivariable linear regression between adults aged ≥75 and <75 years. Among 1000 participants, 19.8% were ≥75 years with a mean age of 79.5±4.1 years. Age ≥75 years was associated with a lower likelihood of technical success (adjusted risk ratio=0.92 [95% CI, 0.86-0.99; P=0.02]) and numerically higher rates of in-hospital major adverse cardiovascular events (9.1% versus 5.9%, P=0.10). There was no difference in Seattle Angina Questionnaire Summary Score at 12 months between adults aged ≥75 and <75 years (adjusted difference=0.9 [95% CI, -1.4 to 3.1; P=0.44]). Conclusions Despite modestly lower success rates and higher complication rates, adults aged ≥75 years experienced angina-related health status benefits after CTO-percutaneous coronary intervention that were similar in magnitude to adults aged <75 years. CTO percutaneous coronary intervention should not be withheld based on age alone in otherwise appropriate candidates.

Keywords: chronic total occlusion; health status; older adults; percutaneous coronary intervention.

PubMed Disclaimer

Figures

Figure 1
Figure 1. Unadjusted health status outcomes at baseline, 1, 6, and 12 months.
At 12 months, adults aged ≥75 years had lower SAQ Physical Limitations scores (P=0.002) and more dyspnea (P=0.001) but overall better SAQ Quality of Life scores (P=0.01). SAQ Summary Scores (P=0.57), SAQ Angina Frequency scores (P=0.95), and percentage of patients with any angina (P=0.50) were similar. RDS indicates Rose Dyspnea Scale; and SAQ; and Seattle Angina Questionnaire.
Figure 2
Figure 2. Adjusted difference in health status outcomes in patients aged ≥75 versus <75 years at 12 months.
Top panel: Difference in Seattle Angina Questionnaire Summary Score and SAQ domains. Positive values indicated better angina‐related health status in patients aged ≥75 years compared with <75 years. Bottom panel: Difference in Rose Dyspnea Scale score. Positive values indicate more dyspnea in adults aged ≥75 years compared with <75 years. RDS indicates Rose Dyspnea Scale; and SAQ, Seattle Angina Questionnaire.
See this image and copyright information in PMC

References

    1. Koelbl CO, Nedeljkovic ZS, Jacobs AK. Coronary chronic total occlusion (CTO): a review. Rev Cardiovasc Med. 2018;19:33–39. doi: 10.31083/j.rcm.2018.01.906 - DOI - PubMed
    1. Ortman JM, Velkoff VA, Hogan H. An aging nation: the older population in the United States. Econ Stat Adm US Dep Commer. Vol 1964; 2014:1–28. https://www.census.gov/content/dam/Census/library/publications/2014/demo... Accessed May 29, 2002.
    1. Peterson ED, Dai D, DeLong ER, Brennan JM, Singh M, Rao SV, Shaw RE, Roe MT, Ho KKL, Klein LW, et al. Contemporary mortality risk prediction for percutaneous coronary intervention: results from 588,398 procedures in the National Cardiovascular Data Registry. J Am Coll Cardiol. 2010;55:1923–1932. doi: 10.1016/j.jacc.2010.02.005 - DOI - PMC - PubMed
    1. Tsai TT, Patel UD, Chang TI, Kennedy KF, Masoudi FA, Matheny ME, Kosiborod M, Amin AP, Weintraub WS, Curtis JP, et al. Validated contemporary risk model of acute kidney injury in patients undergoing percutaneous coronary interventions: insights from the National Cardiovascular Data Registry Cath‐PCI registry. J Am Heart Assoc. 2014;3:e001380. doi: 10.1161/JAHA.114.001380 - DOI - PMC - PubMed
    1. Rao SV, McCoy LA, Spertus JA, Krone RJ, Singh M, Fitzgerald S, Peterson ED. An updated bleeding model to predict the risk of post‐procedure bleeding among patients undergoing percutaneous coronary intervention: a report using an expanded bleeding definition from the National Cardiovascular Data Registry CathPCI registry. JACC Cardiovasc Interv. 2013;6:897–904. doi: 10.1016/j.jcin.2013.04.016 - DOI - PubMed

Publication types

LinkOut - more resources