Comparison of Outcomes After Percutaneous Coronary Intervention in Elderly Patients, Including 10 628 Nonagenarians: Insights From a Japanese Nationwide Registry (J-PCI Registry)

on behalf of the J-PCI Registry Investigators

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Abstract

Background: Scarce data exist about the outcomes after percutaneous coronary intervention (PCI) in old patients. This study sought to provide an overview of PCI in elderly patients, especially nonagenarians, in a Japanese large prospective nationwide registry. Methods and Results: We analyzed 562 640 patients undergoing PCI (≥60 years of age) from 1018 Japanese hospitals between 2014 and 2016 in the J-PCI (Japanese percutaneous coronary intervention) registry. Among them, 10 628 patients (1.9%), including 6780 (1.2%) with acute coronary syndrome (ACS) and 3848 (0.7%) with stable coronary artery disease, were ≥90 years of age. We investigated differences in characteristics and in-hospital outcomes among sexagenarians, septuagenarians, octogenarians, and nonagenarians. Older patients were more frequently women and had a greater frequency of heart failure and chronic kidney disease than younger patients. In addition, older patients had a higher rate of in-hospital mortality, cardiac tamponade, cardiogenic shock after PCI, and bleeding complications requiring blood transfusion. Nonagenarians had the highest risk of in-hospital mortality (odds ratio, 3.60; 95% CI, 3.10–4.18 in ACS; odds ratio, 6.24; 95% CI, 3.82–10.20 in non-ACS) and bleeding complications (odds ratio, 1.79; 95% CI, 1.35–2.36 in ACS; odds ratio, 2.70; 95% CI, 1.68–4.35 in non-ACS) when referenced to sexagenarians. More important, transradial intervention was an inverse independent predictor of both in-hospital mortality and bleeding complications. Conclusions: Older patients, especially nonagenarians, carried a greater risk of in-hospital death and bleeding compared with younger patients after PCI. Transradial intervention might contribute to risk reduction for periprocedural complications in elderly patients undergoing PCI.

Original languageEnglish
Article numbere011183
JournalJournal of the American Heart Association
Volume8
Issue number5
DOIs
Publication statusPublished - 05-03-2019

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Percutaneous Coronary Intervention
Registries
Acute Coronary Syndrome
Hospital Mortality
Odds Ratio
Hemorrhage
Cardiac Tamponade
Cardiogenic Shock
Risk Reduction Behavior
Chronic Renal Insufficiency
Blood Transfusion
Coronary Artery Disease
Heart Failure

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

@article{ac1fe08e90714217ade14d0476213b4b,
title = "Comparison of Outcomes After Percutaneous Coronary Intervention in Elderly Patients, Including 10 628 Nonagenarians: Insights From a Japanese Nationwide Registry (J-PCI Registry)",
abstract = "Background: Scarce data exist about the outcomes after percutaneous coronary intervention (PCI) in old patients. This study sought to provide an overview of PCI in elderly patients, especially nonagenarians, in a Japanese large prospective nationwide registry. Methods and Results: We analyzed 562 640 patients undergoing PCI (≥60 years of age) from 1018 Japanese hospitals between 2014 and 2016 in the J-PCI (Japanese percutaneous coronary intervention) registry. Among them, 10 628 patients (1.9{\%}), including 6780 (1.2{\%}) with acute coronary syndrome (ACS) and 3848 (0.7{\%}) with stable coronary artery disease, were ≥90 years of age. We investigated differences in characteristics and in-hospital outcomes among sexagenarians, septuagenarians, octogenarians, and nonagenarians. Older patients were more frequently women and had a greater frequency of heart failure and chronic kidney disease than younger patients. In addition, older patients had a higher rate of in-hospital mortality, cardiac tamponade, cardiogenic shock after PCI, and bleeding complications requiring blood transfusion. Nonagenarians had the highest risk of in-hospital mortality (odds ratio, 3.60; 95{\%} CI, 3.10–4.18 in ACS; odds ratio, 6.24; 95{\%} CI, 3.82–10.20 in non-ACS) and bleeding complications (odds ratio, 1.79; 95{\%} CI, 1.35–2.36 in ACS; odds ratio, 2.70; 95{\%} CI, 1.68–4.35 in non-ACS) when referenced to sexagenarians. More important, transradial intervention was an inverse independent predictor of both in-hospital mortality and bleeding complications. Conclusions: Older patients, especially nonagenarians, carried a greater risk of in-hospital death and bleeding compared with younger patients after PCI. Transradial intervention might contribute to risk reduction for periprocedural complications in elderly patients undergoing PCI.",
author = "{on behalf of the J-PCI Registry Investigators} and Yohei Numasawa and Taku Inohara and Hideki Ishii and Kyohei Yamaji and Shun Kohsaka and Mitsuaki Sawano and Masaki Kodaira and Shiro Uemura and Kazushige Kadota and Tetsuya Amano and Masato Nakamura and Kazushige Kadota and Nobuo Shiode and Nobuhiro Tanaka and Tetsuya Amano and Shiro Uemura and Takashi Akasaka and Yoshihiro Morino and Kenshi Fujii and Hiroshi Hikichi and Shun Kohsaka and Hideki Ishii and Kengo Tanabe and Yukio Ozaki and Satoru Sumitsuji and Osamu Iida and Hidehiko Hara and Hiroaki Takashima and Shinichi Shirai and Mamoru Nanasato and Taku Inohara and Yasunori Ueda and Yohei Numasawa and Shigetaka Noma",
year = "2019",
month = "3",
day = "5",
doi = "10.1161/JAHA.118.011017",
language = "English",
volume = "8",
journal = "Journal of the American Heart Association",
issn = "2047-9980",
publisher = "Wiley-Blackwell",
number = "5",

}

TY - JOUR

T1 - Comparison of Outcomes After Percutaneous Coronary Intervention in Elderly Patients, Including 10 628 Nonagenarians

T2 - Insights From a Japanese Nationwide Registry (J-PCI Registry)

AU - on behalf of the J-PCI Registry Investigators

AU - Numasawa, Yohei

AU - Inohara, Taku

AU - Ishii, Hideki

AU - Yamaji, Kyohei

AU - Kohsaka, Shun

AU - Sawano, Mitsuaki

AU - Kodaira, Masaki

AU - Uemura, Shiro

AU - Kadota, Kazushige

AU - Amano, Tetsuya

AU - Nakamura, Masato

AU - Kadota, Kazushige

AU - Shiode, Nobuo

AU - Tanaka, Nobuhiro

AU - Amano, Tetsuya

AU - Uemura, Shiro

AU - Akasaka, Takashi

AU - Morino, Yoshihiro

AU - Fujii, Kenshi

AU - Hikichi, Hiroshi

AU - Kohsaka, Shun

AU - Ishii, Hideki

AU - Tanabe, Kengo

AU - Ozaki, Yukio

AU - Sumitsuji, Satoru

AU - Iida, Osamu

AU - Hara, Hidehiko

AU - Takashima, Hiroaki

AU - Shirai, Shinichi

AU - Nanasato, Mamoru

AU - Inohara, Taku

AU - Ueda, Yasunori

AU - Numasawa, Yohei

AU - Noma, Shigetaka

PY - 2019/3/5

Y1 - 2019/3/5

N2 - Background: Scarce data exist about the outcomes after percutaneous coronary intervention (PCI) in old patients. This study sought to provide an overview of PCI in elderly patients, especially nonagenarians, in a Japanese large prospective nationwide registry. Methods and Results: We analyzed 562 640 patients undergoing PCI (≥60 years of age) from 1018 Japanese hospitals between 2014 and 2016 in the J-PCI (Japanese percutaneous coronary intervention) registry. Among them, 10 628 patients (1.9%), including 6780 (1.2%) with acute coronary syndrome (ACS) and 3848 (0.7%) with stable coronary artery disease, were ≥90 years of age. We investigated differences in characteristics and in-hospital outcomes among sexagenarians, septuagenarians, octogenarians, and nonagenarians. Older patients were more frequently women and had a greater frequency of heart failure and chronic kidney disease than younger patients. In addition, older patients had a higher rate of in-hospital mortality, cardiac tamponade, cardiogenic shock after PCI, and bleeding complications requiring blood transfusion. Nonagenarians had the highest risk of in-hospital mortality (odds ratio, 3.60; 95% CI, 3.10–4.18 in ACS; odds ratio, 6.24; 95% CI, 3.82–10.20 in non-ACS) and bleeding complications (odds ratio, 1.79; 95% CI, 1.35–2.36 in ACS; odds ratio, 2.70; 95% CI, 1.68–4.35 in non-ACS) when referenced to sexagenarians. More important, transradial intervention was an inverse independent predictor of both in-hospital mortality and bleeding complications. Conclusions: Older patients, especially nonagenarians, carried a greater risk of in-hospital death and bleeding compared with younger patients after PCI. Transradial intervention might contribute to risk reduction for periprocedural complications in elderly patients undergoing PCI.

AB - Background: Scarce data exist about the outcomes after percutaneous coronary intervention (PCI) in old patients. This study sought to provide an overview of PCI in elderly patients, especially nonagenarians, in a Japanese large prospective nationwide registry. Methods and Results: We analyzed 562 640 patients undergoing PCI (≥60 years of age) from 1018 Japanese hospitals between 2014 and 2016 in the J-PCI (Japanese percutaneous coronary intervention) registry. Among them, 10 628 patients (1.9%), including 6780 (1.2%) with acute coronary syndrome (ACS) and 3848 (0.7%) with stable coronary artery disease, were ≥90 years of age. We investigated differences in characteristics and in-hospital outcomes among sexagenarians, septuagenarians, octogenarians, and nonagenarians. Older patients were more frequently women and had a greater frequency of heart failure and chronic kidney disease than younger patients. In addition, older patients had a higher rate of in-hospital mortality, cardiac tamponade, cardiogenic shock after PCI, and bleeding complications requiring blood transfusion. Nonagenarians had the highest risk of in-hospital mortality (odds ratio, 3.60; 95% CI, 3.10–4.18 in ACS; odds ratio, 6.24; 95% CI, 3.82–10.20 in non-ACS) and bleeding complications (odds ratio, 1.79; 95% CI, 1.35–2.36 in ACS; odds ratio, 2.70; 95% CI, 1.68–4.35 in non-ACS) when referenced to sexagenarians. More important, transradial intervention was an inverse independent predictor of both in-hospital mortality and bleeding complications. Conclusions: Older patients, especially nonagenarians, carried a greater risk of in-hospital death and bleeding compared with younger patients after PCI. Transradial intervention might contribute to risk reduction for periprocedural complications in elderly patients undergoing PCI.

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UR - http://www.scopus.com/inward/citedby.url?scp=85061991364&partnerID=8YFLogxK

U2 - 10.1161/JAHA.118.011017

DO - 10.1161/JAHA.118.011017

M3 - Article

C2 - 30791799

AN - SCOPUS:85061991364

VL - 8

JO - Journal of the American Heart Association

JF - Journal of the American Heart Association

SN - 2047-9980

IS - 5

M1 - e011183

ER -