Kashish Goel1, Tanush Gupta2, Rajiv Gulati1, Malcolm R Bell1, Dhaval Kolte3, Sahil Khera4, Deepak L Bhatt5, Charanjit S Rihal1, David R Holmes6. 1. Mayo Clinic, Rochester, Minnesota. 2. Montefiore Medical Center, Bronx, New York. 3. Brown University, Providence, Rhode Island. 4. Massachusetts General Hospital, Boston, Massachusetts. 5. Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts. 6. Mayo Clinic, Rochester, Minnesota. Electronic address: holmes.david@mayo.edu.
Abstract
OBJECTIVES: This study sought to assess temporal trends and outcomes of percutaneous coronary intervention (PCI) in nonagenarians. BACKGROUND: With increasing life expectancy, nonagenarians requiring PCI are increasing even though outcomes data are limited. METHODS: The National Inpatient Sample was used to identify all hospitalizations for PCI in patients aged ≥90 years from January 1, 2003, to December 31, 2014. The primary outcome was in-hospital mortality. RESULTS: Nonagenarians (n = 69,271) constituted 0.9% of all PCI hospitalizations, increasing from 0.6% in 2003 to 2004 to 1.4% in 2013 to 2014 (ptrend < 0.001). From 2003-2004 to 2013-2014, the proportion of PCIs performed for ST-segment elevation myocardial infarction (STEMI) (23.1% to 30.9%) and non-ST-segment elevation acute coronary syndromes (49.6% to 52.6%) increased, whereas those for stable ischemic heart disease (SIHD) decreased (27.3% to 16.5%), respectively (ptrend < 0.001 for all). Overall in-hospital mortality after PCI for STEMI, non-ST-segment elevation acute coronary syndromes, and SIHD were 16.4%, 4.2%, and 1.8%, respectively. After multivariable risk adjustment for demographics, comorbidities, and hospital-level characteristics, in-hospital mortality remained unchanged in STEMI (odds ratio: 1.04; 95% confidence interval: 0.98 to 1.11; ptrend = 0.20) and non-ST-segment elevation acute coronary syndromes (odds ratio: 0.99; 95% confidence interval: 0.91 to 1.08; ptrend = 0.82), but increased in SIHD (odds ratio: 1.21; 95% confidence interval: 1.01 to 1.44; ptrend = 0.04) from 2003 to 2004 to 2013 to 2014. The rates of bleeding and vascular complications decreased or remained stable in all 3 subgroups, whereas risk-adjusted incidence of stroke increased in patients with STEMI or SIHD. CONCLUSIONS: The rate of in-hospital mortality, major bleeding, vascular complications, and stroke after PCI in nonagenarians changed significantly from 2003 to 2014. This study provides a benchmark for discussion of PCI-related risks among physicians, patients, and families.
OBJECTIVES: This study sought to assess temporal trends and outcomes of percutaneous coronary intervention (PCI) in nonagenarians. BACKGROUND: With increasing life expectancy, nonagenarians requiring PCI are increasing even though outcomes data are limited. METHODS: The National Inpatient Sample was used to identify all hospitalizations for PCI in patients aged ≥90 years from January 1, 2003, to December 31, 2014. The primary outcome was in-hospital mortality. RESULTS: Nonagenarians (n = 69,271) constituted 0.9% of all PCI hospitalizations, increasing from 0.6% in 2003 to 2004 to 1.4% in 2013 to 2014 (ptrend < 0.001). From 2003-2004 to 2013-2014, the proportion of PCIs performed for ST-segment elevation myocardial infarction (STEMI) (23.1% to 30.9%) and non-ST-segment elevation acute coronary syndromes (49.6% to 52.6%) increased, whereas those for stable ischemic heart disease (SIHD) decreased (27.3% to 16.5%), respectively (ptrend < 0.001 for all). Overall in-hospital mortality after PCI for STEMI, non-ST-segment elevation acute coronary syndromes, and SIHD were 16.4%, 4.2%, and 1.8%, respectively. After multivariable risk adjustment for demographics, comorbidities, and hospital-level characteristics, in-hospital mortality remained unchanged in STEMI (odds ratio: 1.04; 95% confidence interval: 0.98 to 1.11; ptrend = 0.20) and non-ST-segment elevation acute coronary syndromes (odds ratio: 0.99; 95% confidence interval: 0.91 to 1.08; ptrend = 0.82), but increased in SIHD (odds ratio: 1.21; 95% confidence interval: 1.01 to 1.44; ptrend = 0.04) from 2003 to 2004 to 2013 to 2014. The rates of bleeding and vascular complications decreased or remained stable in all 3 subgroups, whereas risk-adjusted incidence of stroke increased in patients with STEMI or SIHD. CONCLUSIONS: The rate of in-hospital mortality, major bleeding, vascular complications, and stroke after PCI in nonagenarians changed significantly from 2003 to 2014. This study provides a benchmark for discussion of PCI-related risks among physicians, patients, and families.
Authors: Mohammed M N Meah; Tobin Joseph; Wern Yew Ding; Matthew Shaw; Jonathan Hasleton; Nick D Palmer; Periaswamy Velavan; Suneil K Aggarwal Journal: BMC Cardiovasc Disord Date: 2021-01-13 Impact factor: 2.298
Authors: Sourbha S Dani; Abdul Mannan Khan Minhas; Adeel Arshad; Troy Krupica; Sachin S Goel; Salim S Virani; Garima Sharma; Ron Blankstein; Michael J Blaha; Sadeer G Al-Kindi; Khurram Nasir; Safi U Khan Journal: J Am Heart Assoc Date: 2021-08-28 Impact factor: 5.501