TY - JOUR
T1 - One-year outcome after percutaneous coronary intervention in nonagenarians
T2 - Insights from the J-PCI OUTCOME registry
AU - Otowa, Kanichi
AU - Kohsaka, Shun
AU - Sawano, Mitsuaki
AU - Matsuura, Shintaro
AU - Chikata, Akio
AU - Maruyama, Michiro
AU - Usuda, Kazuo
AU - Watanabe, Tetsu
AU - Ishii, Hideki
AU - Amano, Tetsuya
AU - Nakamura, Masato
AU - Ikari, Yuji
N1 - Publisher Copyright:
© 2022 Elsevier Inc.
PY - 2022/4
Y1 - 2022/4
N2 - Background: Nonagenarian patients who undergo percutaneous coronary intervention (PCI) are increasing, and a few previous studies have reported their long-term outcomes. However, differences in their long-term outcomes between generations remain unclear. This study aimed to investigate 1-year all-cause and cardiovascular (CV) mortality, and major adverse cardiovascular events (MACE; cardiovascular death, myocardial infarction, and stroke) of nonagenarian patients who underwent PCI compared with the other elder patients, using a nationwide registration system. Methods: The patient-level data registered between January 2017 and December 2017 was extracted from the J-PCI OUTCOME Registry endorsed by the Japanese Association of Cardiovascular Intervention and Therapeutics (CVIT). The one-year all-cause and cardiovascular (CV) mortality, MACE, and major bleeding events were identified. Results: Out of 40,722 patients over 60 years of age, 880 (2.1%) were nonagenarians. For nonagenarians, the 1-year mortality rate was substantial (13.5%). The MACE and CV death rates were also high (8.1%, and 6.8%, respectively) for nonagenarians, and these event rates were approximately 1.5 times higher in nonagenarians than octogenarians. Multivariate regression analysis showed that presentation with cardiogenic shock [hazard ratio (HR) 2.32; 95 confidence intervals (CI): 1.22–4.41], or cardiac arrest (HR 2.91; 90% CI: 1.28–6.62), and use of oral anticoagulants (HR 2.10; 90% CI: 1.07–4.12) were the predictors of 1-year MACE. Conclusions: Even in the contemporary era, nonagenarians who have undergone PCI still face a considerably increased risk for adverse cardiovascular events that reduces long-term survival. In addition to having poorer lesion characteristics, adverse events, including death, MACEs, and major bleeding, occurred 1.5 times more frequently in nonagenarians than in octogenarians.
AB - Background: Nonagenarian patients who undergo percutaneous coronary intervention (PCI) are increasing, and a few previous studies have reported their long-term outcomes. However, differences in their long-term outcomes between generations remain unclear. This study aimed to investigate 1-year all-cause and cardiovascular (CV) mortality, and major adverse cardiovascular events (MACE; cardiovascular death, myocardial infarction, and stroke) of nonagenarian patients who underwent PCI compared with the other elder patients, using a nationwide registration system. Methods: The patient-level data registered between January 2017 and December 2017 was extracted from the J-PCI OUTCOME Registry endorsed by the Japanese Association of Cardiovascular Intervention and Therapeutics (CVIT). The one-year all-cause and cardiovascular (CV) mortality, MACE, and major bleeding events were identified. Results: Out of 40,722 patients over 60 years of age, 880 (2.1%) were nonagenarians. For nonagenarians, the 1-year mortality rate was substantial (13.5%). The MACE and CV death rates were also high (8.1%, and 6.8%, respectively) for nonagenarians, and these event rates were approximately 1.5 times higher in nonagenarians than octogenarians. Multivariate regression analysis showed that presentation with cardiogenic shock [hazard ratio (HR) 2.32; 95 confidence intervals (CI): 1.22–4.41], or cardiac arrest (HR 2.91; 90% CI: 1.28–6.62), and use of oral anticoagulants (HR 2.10; 90% CI: 1.07–4.12) were the predictors of 1-year MACE. Conclusions: Even in the contemporary era, nonagenarians who have undergone PCI still face a considerably increased risk for adverse cardiovascular events that reduces long-term survival. In addition to having poorer lesion characteristics, adverse events, including death, MACEs, and major bleeding, occurred 1.5 times more frequently in nonagenarians than in octogenarians.
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U2 - 10.1016/j.ahj.2022.01.004
DO - 10.1016/j.ahj.2022.01.004
M3 - Article
C2 - 35016854
AN - SCOPUS:85123588550
SN - 0002-8703
VL - 246
SP - 105
EP - 116
JO - American Heart Journal
JF - American Heart Journal
ER -