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
N1 - Publisher Copyright:
© 2019 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
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.
KW - nonagenarians
KW - octogenarians
KW - percutaneous coronary intervention
KW - transradial intervention
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U2 - 10.1161/JAHA.118.011017
DO - 10.1161/JAHA.118.011017
M3 - Article
C2 - 30791799
AN - SCOPUS:85061991364
SN - 2047-9980
VL - 8
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 5
M1 - e011183
ER -