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PCI in Nonagenarians: A PRIC study of in-hospital mortality and trends in procedural complexity
Session:
CO 06 - Intervenção Coronária
Speaker:
Afonso Félix Oliveira
Congress:
CPC 2018
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.2 Coronary Intervention
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Afonso Félix De Oliveira; Rui Campante Teles; Pedro Canas Da Silva; Marco Costa; Helder Pereira; Pedro Farto e Abreu; Filipe Seixo; Henrique Cyrne Carvalho; João Luís Pipa; Francisco Pereira Machado; Luis Bernardes; On behalf of PRIC investigators
Abstract
<p><strong>Background:</strong> An increasing number of nonagenarians is being submitted to PCI. The outcomes and predictors of adverse events in this population are largely unknown. PCI technical innovations such as the use of DES and radial access have improved morbi-mortalitity. However, the implementation and impact of such practices are not defined.</p> <p><strong>Methods: </strong>Consecutive PCIs in patients older than 65 years old, enrolled in the Portuguese registry on interventional cardiology (PRIC) and submitted to PCI from 2006 to 2017 were included. Data was registered prospectively.</p> <p><strong>Results: </strong>42 669 PCIs performed in patients between 65-89 yo and 456 PCIs in patients older than 90 yo were included. The annual number of PCIs performed in nonagenarians increased from 11 in 2007 to 94 in 2016 (<em>p</em> for trend < 0.05). Nonagenarians were more frequently female (51 vs 33%, p< 0.05), had congestive heart failure (7,7% vs 4,6%, p<0.05) and kidney disease (11 vs 8,2%, p< 0.05). The most common indication for PCI in nonagenarians was STEMI with a prevalence of 36%, in contrast to the most common indication in 65-79yo patients which was elective PCI (28.9%; p<0.05). Left main (LM) and left anterior descendent artery (LAD) PCI were more often performed in nonagenarians (LM: 6.9% vs 2.9%; LAD: 55.9% vs 46.8% - p<0.05). Radial access was equally used in both groups of patients (49.1 vs 46.5%, p = n.s.). In contrast, the use of DES was more common in younger patients (49% vs 71.5%, p< 0.05) and temporal trend analysis showed a significant difference between both groups during the last decade, with a late equalization in 2016 (94.3 vs 96.9%). Regarding short-term outcomes, being a nonagenarian was an independent predictor of in-hospital (IH) mortality (p < 0.05). Among nonagenarians, STEMI and non-radial access were independent predictors of IH mortality (p< 0.05 ; ROC curve AUC 95%CI: 0.677-0.863); during the last decade, STEMI rate has remained constant (34 – 48.1%, <em>p</em> for trend = n.s.) but non-radial access has gradually decreased (100 to 40.4%, p for trend < 0.05). Nevertheless, IH mortality has not consistently varied (0 - 11.6%, <em>p</em> for trend = n.s.). </p> <p><strong>Conclusions: </strong>PCI in nonagenarians became more common in Portugal, predominantly due to STEMI. The non-radial approach was an independent predictor of in-hospital mortality and it´s use has decreased. </p>
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