Prognostic impact of percutaneous coronary intervention in octogenarians with non-ST elevation myocardial infarction: A report from SWEDEHEART

Eur Heart J Acute Cardiovasc Care. 2020 Aug;9(5):480-487. doi: 10.1177/2048872619877287. Epub 2019 Sep 13.

Abstract

Aims: Percutaneous coronary intervention (PCI) improves outcomes in non-ST elevation acute coronary syndromes (NSTE-ACSs). Octogenarians, however, were underrepresented in the pivotal trials. This study aimed to assess the effect of PCI in patients ≥80 years old.

Methods and results: We used data from the SWEDEHEART registry for all hospital admissions at eight cardiac care centres within Västra Götaland County. Consecutive patients ≥80 years old admitted for NSTE-ACS between January 2000 and December 2011 were included. We performed instrumental variable analysis with propensity score. The primary endpoint was all-cause mortality at 30 days and one year after index hospitalization. During the study period 5200 patients fulfilled the inclusion criteria. In total, 586 (11.2%) patients underwent PCI, the remaining 4613 patients were treated conservatively. Total mortality at 30 days was 19.4% (1007 events) and 39.4% (1876 events) at one year. Thirty-day mortality was 20.7% in conservatively treated patients and 8.5% in the PCI group (adjusted odds ratio 0.34; 95% confidence interval 0.12-0.97, p = 0.044). One-year mortality was 42.1% in the conservatively treated group and 16.3% in the PCI group (adjusted odds ratio 0.97; 95% confidence interval 0.36-2.51, p = 0.847).

Conclusions: PCI in octogenarians with NSTE-ACS was associated with a lower risk of mortality at 30 days. However, this survival benefit was not sustained during the entire study-period of one-year.

Keywords: acute coronary syndrome; long-term follow-up; non-ST elevation acute coronary syndromes; non-ST elevation myocardial infarction; nonagenarian restenosis; octogenarian; percutaneous coronary intervention; unstable angina.

Publication types

  • Multicenter Study

MeSH terms

  • Aged, 80 and over
  • Denmark / epidemiology
  • Female
  • Humans
  • Male
  • Non-ST Elevated Myocardial Infarction / mortality*
  • Non-ST Elevated Myocardial Infarction / surgery
  • Percutaneous Coronary Intervention / methods*
  • Prognosis
  • Propensity Score*
  • Registries*
  • Retrospective Studies
  • Risk Factors
  • Survival Rate / trends