TY - JOUR
T1 - Chronic total occlusion percutaneous coronary intervention in octogenarians and nonagenarians
AU - Vemmou, Evangelia
AU - Alaswad, Khaldoon
AU - Patel, Mitul
AU - Mahmud, Ehtisham
AU - Choi, James W.
AU - Jaffer, Farouc A.
AU - Doing, Anthony H.
AU - Dattilo, Phil
AU - Karmpaliotis, Dimitri
AU - Krestyaninov, Oleg
AU - Khelimskii, Dmitrii
AU - Nikolakopoulos, Ilias
AU - Karacsonyi, Judit
AU - Xenogiannis, Iosif
AU - Garcia, Santiago
AU - Burke, M. Nicholas
AU - Abi Rafeh, Nidal
AU - ElGuindy, Ahmed
AU - Goktekin, Omer
AU - Abdo, Abir
AU - Rangan, Bavana V.
AU - Abdullah, Shuaib
AU - Brilakis, Emmanouil S.
N1 - Funding Information:
Emmanouil S. Brilakis: consulting/speaker honoraria from Abbott Vascular, American Heart Association (associate editor Circulation), Amgen, Biotronik, Boston Scientific, Cardiovascular Innovations Foundation (Board of Directors), ControlRad, CSI, Ebix, Elsevier, GE Healthcare, InfraRedx, Medtronic, Siemens, and Teleflex; research support from Regeneron and Siemens; owner, Hippocrates LLC; shareholder: MHI Ventures.
Funding Information:
Bavana V. Rangan: research grants from InfraReDx, Inc, and the Spectranetics Corporation.
Publisher Copyright:
© 2021 The American Geriatrics Society
PY - 2021/6
Y1 - 2021/6
N2 - Objective: The outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in octogenarians and nonagenarians have received limited study. Methods: We compared in-hospital outcomes of CTO PCI between patients ≥80 vs. <80-years-old in 6233 CTO PCIs performed between 2012 and 2020 at 33 U.S. and international centers. Results: There were 415 octogenarians and nonagenarians in our study (7% of the total population). Compared with younger patients, octo- and nonagenarians were less likely to be men (73% vs. 83.2%, p < 0.0001) and more likely to have atrial fibrillation (27% vs. 12%, p < 0.0001) and prior coronary artery bypass graft surgery (CABG) (43% vs. 29%, p < 0.0001). They were more likely to have CTOs with moderate/severe calcification (71% vs. 46%, p < 0.0001), but had similar mean J-CTO scores (2.5 ± 1.3 vs. 2.4 ± 1.3, p = 0.08). They had lower technical and procedural success (82.2% vs. 86.3%, p = 0.0201; 80.3% vs. 84.8%, p = 0.016, respectively) and higher incidence of in-hospital major adverse cardiovascular events (3.4% vs. 1.8%, p = 0.021). On multivariable analysis PCI in octo- and nonagenarians was not independently associated with technical and procedural success or with in-hospital MACE. Conclusion: CTO PCI is feasible in octo- and nonagenarians, although success rates are lower, and the risk of complications is higher compared with younger patients, likely related to more comorbidities and higher coronary lesion complexity.
AB - Objective: The outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in octogenarians and nonagenarians have received limited study. Methods: We compared in-hospital outcomes of CTO PCI between patients ≥80 vs. <80-years-old in 6233 CTO PCIs performed between 2012 and 2020 at 33 U.S. and international centers. Results: There were 415 octogenarians and nonagenarians in our study (7% of the total population). Compared with younger patients, octo- and nonagenarians were less likely to be men (73% vs. 83.2%, p < 0.0001) and more likely to have atrial fibrillation (27% vs. 12%, p < 0.0001) and prior coronary artery bypass graft surgery (CABG) (43% vs. 29%, p < 0.0001). They were more likely to have CTOs with moderate/severe calcification (71% vs. 46%, p < 0.0001), but had similar mean J-CTO scores (2.5 ± 1.3 vs. 2.4 ± 1.3, p = 0.08). They had lower technical and procedural success (82.2% vs. 86.3%, p = 0.0201; 80.3% vs. 84.8%, p = 0.016, respectively) and higher incidence of in-hospital major adverse cardiovascular events (3.4% vs. 1.8%, p = 0.021). On multivariable analysis PCI in octo- and nonagenarians was not independently associated with technical and procedural success or with in-hospital MACE. Conclusion: CTO PCI is feasible in octo- and nonagenarians, although success rates are lower, and the risk of complications is higher compared with younger patients, likely related to more comorbidities and higher coronary lesion complexity.
KW - chronic total occlusion
KW - octogenarians
KW - percutaneous coronary intervention
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U2 - 10.1111/jgs.17063
DO - 10.1111/jgs.17063
M3 - Article
C2 - 33591578
AN - SCOPUS:85100927982
SN - 0002-8614
VL - 69
SP - 1560
EP - 1569
JO - Journal of the American Geriatrics Society
JF - Journal of the American Geriatrics Society
IS - 6
ER -