WASHINGTON – Octogenarians rejected for coronary surgical revascularization can expect outcomes from percutaneous coronary intervention similar to those provided to younger patients who have also been considered to be too high risk for surgery, according to an experience reported by researchers from the University of Southern California, Los Angeles, at the Cardiovascular Research Technologies 2016 conference, sponsored by the Cardiovascular Research Institute at Washington Hospital Center. In a series of patients requiring revascularization for unprotected left main coronary artery (ULMCA) stenosis, there were no significant differences in either short-term or long-term outcomes, reported Dr. Meena R. Narayanan of the University of Southern California, Los Angeles.
The analysis was based on a series of 71 patients with ULMCA stenosis who were considered to be too high risk for surgical revascularization and underwent percutaneous coronary intervention and stent placement as an alternative. Of these, 18 were more than 80 years of age and 53 were younger.
When the two groups were compared, most of the baseline characteristics were similar. However, there were exceptions. Diabetes mellitus was substantially more frequent in the younger patients (55% vs. 22%) but advanced chronic kidney disease was far more common in the octogenarians (61% vs. 30%).
The octogenarians also had significantly higher Society of Thoracic Surgeons (STS) scores (14.1 vs. 6.5; P = .009) and higher European System for Cardiac Operative Risk Evaluation (EUROSCORE) numbers (17.0 vs. 8.2; P = .01), both signifying a worse prognosis. However, both scoring systems use older age as an incremental factor for increased risk.
Regarding mortality, both the 30-day (17% vs. 4%) and the 1-year (28% vs. 21%) rates were higher for the octogenarians relative to those younger, but neither difference reached statistical significance, according to Dr. Narayanan. There also did not appear to be any differences in complications during acute recovery after percutaneous coronary intervention. For example, the need for temporary dialysis was exactly the same (20% in both groups) and the average length of stay, although longer among those older (12.0 vs. 8.4 days), also did not differ significantly.
“Elderly patients are well known to have higher mortality rates associated with coronary surgical revascularization,” reported Dr. Narayanan, but these data suggest that stenting is a reasonable alternative. It is notable that this study is not the first to suggest that age above 80 years may not be an appropriate exclusion factor for coronary stenting. In a study published 3 years ago, outcomes were evaluated in 70 consecutive patients 80 years of age or older undergoing left main coronary stenting (Cardiovasc Revasc Med. 2012;13:119-24). In-hospital mortality was 11% but overall mortality after a mean follow-up time of 30.5 months was 28%, which was considered reasonable in a high-risk population.
The authors of the 2012 study, like Dr. Narayanan, concluded that stenting appears to be a reasonable approach in octogenarians who are not candidates for surgical revascularization.