Complex Percutaneous Coronary Intervention Outcomes in Older Adults

Abstract

Background Complex percutaneous coronary intervention (PCI) is increasingly performed in older adults (age ≥75 years) with stable ischemic heart disease. However, little is known about clinical outcomes. Methods and Results We derived a cohort of older adults undergoing elective PCI for stable ischemic heart disease across a large health system. We compared 12-month event-free survival (freedom from all-cause death, nonfatal myocardial infarction, stroke, and major bleeding), all-cause death, target lesion revascularization, and bleeding events for patients receiving complex versus noncomplex PCI and derived risk estimates with Cox regression models. We included 513 patients (mean age, 81±5 years). Patients receiving complex PCI versus noncomplex PCI did not significantly differ across a host of clinical characteristics including cardiovascular disease features, noncardiac comorbidities, guideline-directed medical therapy use, and frailty. Patients receiving complex PCI versus noncomplex PCI experienced worse event-free survival (80.4% versus 86.8%), which was not significant in adjusted analyses (hazard ratio [HR], 1.38 [95% CI, 0.88-2.16]). All-cause death at 1 year for patients undergoing complex PCI was nearly double that seen for patients receiving noncomplex PCI (10.2% versus 5.9%), and the risk was significant in models adjusted for clinical characteristics (HR, 1.97 [95% CI, 1.02-3.79]). Target lesion revascularization risk was lower for patients receiving complex PCI (2.2% versus 3.5%, adjusted HR), but bleeding events were not statistically different between groups (25.3% versus 20.5%; P=0.19). Conclusions Complex PCI in older adults with stable ischemic heart disease was associated with lower risk of target lesion revascularization but higher all-cause death compared with noncomplex PCI.

Keywords: complex percutaneous coronary intervention; coronary artery disease; older adults; revascularization.

Figure 1. Kaplan–Meier curves for event‐free survival.

Figure displays the Kaplan–Meier survival curves (survival function probability vs time from coronary intervention in days) for the event‐free survival (freedom from all‐cause death, nonfatal myocardial infarction/stroke, and target lesion revascularization) at 12 months from index percutaneous coronary intervention (PCI). The blue curve represents the group receiving noncomplex PCI, and the red curve represents the group receiving complex PCI.

Figure 2. Kaplan–Meier curves for secondary outcomes.

Figure displays the Kaplan–Meier survival curves (survival function probability vs time from coronary intervention in days) for all‐cause death (left) and target lesion revascularization (right) at 12 months from index percutaneous coronary intervention (PCI). At‐risk tables are shown below each respective graph. The blue curves represent the group receiving noncomplex PCI, and the red curves represent the group receiving complex PCI.