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. 2022 Aug 24;1(5):100442.
doi: 10.1016/j.jscai.2022.100442. eCollection 2022 Sep-Oct.

Prognosis of PCI in the Older Adult Population: Outcomes From the Multicenter Prospective e-ULTIMASTER Registry

Majdi Saada  1 , Ofer Kobo  1 , Floris Kauer  2 , Orazbek Sakhov  3 , Peep Laanmets  4 , Rajpal Abhaichand  5 , Iñigo Lozano  6 , Jim Crowley  7 , Gurupreet Singh Wander  8 , Mamas A Mamas  9 , Ariel Roguin  1 ; e-ULTIMASTER Investigators
Affiliations

Prognosis of PCI in the Older Adult Population: Outcomes From the Multicenter Prospective e-ULTIMASTER Registry

Majdi Saada et al. J Soc Cardiovasc Angiogr Interv. .

Abstract

Background: Older adult patients undergoing percutaneous coronary intervention (PCI) are usually excluded from clinical trials. This study aimed to assess 1-year clinical outcomes in patients aged >80 years.

Methods: This all-comer registry included patients who underwent PCI using the Ultimaster stent. Primary clinical endpoint was target lesion failure (TLF), a composite of cardiac death (CD), target vessel-related myocardial infarction (TV-MI), or clinically indicated target lesion revascularization (CD-TLR).

Results: In total, 3286 (8.8%) patients aged ≥80 years were compared with 33,912 patients aged <80 years. The older adult patients included more women, had more comorbidities and exhibited more complex coronary anatomy. The incidence of TLF was higher in the older adult group (5.6% vs 3.0%, P < .0001), as well as for all-cause mortality (6.2% vs 1.7%, P < .0001), CD (3.3% vs 1.1%, P < .0001), and TV-MI (1.7% vs 0.8%, P < .0001), but not for CD-TLR (1.9% vs 1.7%, P = .15). After the inverse propensity score weighted analysis, aged ≥80 years was associated with increased risk of TLF (HR, 1.42; 95% CI, 1.22-1.66; P < .0001), CD (HR, 1.67; 95% CI, 1.136-2.06; P < .0001), and TV-MI (HR, 1.66; 95% CI, 1.24-2.24; P < .001) but not for CD-TLR (HR, 1.10; 95% CI, 0.85-1.43; P = .45).

Conclusion: Older adult patients had a higher incidence of TLF, CD, and TV-MI but with no difference in the incidence of recurrent revascularization or stent thrombosis. Although PCI in older adults is relatively safe, higher rates of cardiac events should be considered.

Keywords: age; coronary artery disease; elderly; older adults; outcome; stent; vascular disease.

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Figures

None
Cardiac event rates after PCI.
Figure 1
Figure 1
Flowchart of the study.
Figure 2
Figure 2
Outcome after propensity score adjustment. Kaplan–Meier cumulative incidence of event curves after inverse-weighted propensity score adjustment: target lesion failure (A), cardiac death, (B) target vessel–related myocardial infarction, (C) and clinically driven target lesion revascularization (D).
Figure 3
Figure 3
Cumulative event rates after propensity score adjustment at 1-year showing higher event rates for the older adult group except for the revascularizations. CD-TVR, clinically driven target vessel revascularization; CD-TLR, clinically driven target lesion revascularization; MI, myocardial infarction; TV-MI, target vessel–related myocardial infarction; ST, stent thrombosis (definite/probable).
Central Illustration
Central Illustration
Cardiac event rates in older adults (≥80 years) after PCI. Older adults had a higher incidence of target lesion failure, cardiac death, target vessel myocardial infarction, but not for target lesion revascularization.
Supplementary Figure 1
Supplementary Figure 1
See this image and copyright information in PMC

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