Long-Term Clinical Outcomes of Percutaneous Coronary Intervention Using Drug-Eluting Stents in Octogenarians and Older

Sun Hwa Lee; Jei Keon Chae

doi:10.4070/kcj.2007.37.12.647

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Lee and Chae: Long-Term Clinical Outcomes of Percutaneous Coronary Intervention Using Drug-Eluting Stents in Octogenarians and Older

Original Article

Korean Circulation Journal

Korean Circulation Journal 2007; 37(12): 647-655.

Published online: 31 December 2007

DOI: https://doi.org/10.4070/kcj.2007.37.12.647

Long-Term Clinical Outcomes of Percutaneous Coronary Intervention Using Drug-Eluting Stents in Octogenarians and Older

Sun Hwa Lee, MD, Jei Keon Chae, MD

Division of Cardiology, Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea.

Correspondence: Jei Keon Chae, MD, Division of Cardiology, Department of Internal Medicine, Chonbuk National University Medical School, San 2-20 Geumam-dong, Deokjin-gu, Jeonju 561-180, Korea. Tel: 82-63-250-1839, Fax: 82-63-250-1680, jkchae@chonbuk.ac.kr

Received 27 August 2007 Accepted 13 September 2007

Abstract

Background and Objectives

In this current era of using drug-eluting stents (DES), studies that demonstrate the feasibility and clinical outcome of percutaneous coronary intervention (PCI) using DES in a subset of extremely aged patients are lacking. We investigated the clinical characteristics, therapeutic and clinical outcomes of patients older than 80 years that had been implanted with DES during a PCI.

Subjects and Methods

Fifty-three "octogenarian" patients (≥80-years-old) and 1036 "non-octogenarian" patients (<80-years-old) that had been implanted with DES at Chonbuk National University Hospital since March 2003 were enrolled in the study. Medical records of the patients in the two groups were retrospectively reviewed.

Results

The mean ages of the patients in the two groups were 83±2 years and 62±11 years, respectively, and the mean follow-up period was 15.8±10.9 months and 21.1±10.8 months, respectively. The octogenarian group showed an increased prevalence of female patients (58.5% vs. 35.1%, p=0.001), acute coronary syndrome (98.1% vs. 78.6%, p=0.001), ST-segment elevation myocardial infarction (41.5% vs. 28.3%, p=0.003), shock (17.0% vs. 6.6%, p=0.004), heart failure (22.6% vs. 9.3%, p=0.002) and a higher in-hospital major adverse cardiac event (MACE) rate (13.2% vs. 3.5%, p=0.004) than the non-octogenarian patients. Angiographic restenosis and target lesion revascularization rates were not different in both groups, but overall MACE (18.9% vs. 9.9%, p=0.035) and all-cause mortality (p<0.001) rates were significantly higher in the octogenarian group of patients.

Conclusion

Although angiographic follow-up results were comparable in octogenarians and non-octogenarians, the occurrence of short- and long-term MACE was significantly higher in the very elderly group owing to a substantial subset of high-risk patients.

Keywords: Aged, 80 and over, Coronary disease, Stents

Figures and Tables

Fig. 1

Kaplan-Meier curve showing mortality-free survival.

Table 1

Baseline characteristics

MI: myocardial infarction, PCI: percutaneous coronary intervention, CABG: coronary artery bypass graft, CHD: coronary heart disease, PAOD: peripheral arterial occlusive disease

Table 2

Clinical presentations

^*Calculated by Cockcroft-Gault equation.19) STEMI: ST-segment elevation myocardial infarction, NSTEMI: non-ST-segment elevation myocardial infarction, LV EF: left ventricular ejection fraction, CKD: chronic kidney disease, ESRD: end-stage renal disease

Table 3

Procedural and angiographic characteristics

^*ACC/AHA lesion classification system.20) PCI: percutaneous coronary intervention, LMCA: left main coronary artery, LAD: left anterior descending artery, LCX: left circumflex artery, RCA: right coronary artery, SVG: saphenous vein graft, ACC/AHA: American College of Cardiology/American Heart Association, DES: drug-eluting stents, SES: sirolimus-eluting stent, PES: paclitaxel-eluting stent, ZES: zotarolimus-eluting stent

Table 4

Procedure-related events and in-hospital MACE

MACE: major adverse cardiac events (defined as death, myocardial infarction or target lesion or vessel revascularization), PCI: percutaneous coronary intervention

Table 5

Follow-up data

MACE: major adverse cardiac events (defined as death, myocardial infarction or target lesion or vessel revascularization), TLR: target lesion revascularization, TVR: target vessel revascularization, CAG: coronary angiography

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