In-hospital Outcome of Percutaneous Coronary Intervention among Very Elderly Patients with Ischemic Heart Disease in a Dedicated Cardiac Hospital

Bangladesh Heart Journal Pub Date : 2020-09-15 DOI:10.3329/bhj.v35i1.49144

Mohammad Arifur Rahman, Afzalur Rahman, Mohammd Mahbubur Rahman, Farhana Ahmed, Md. Kamrul Hasan, J. Farjana, Md Azizur Rahaman Majumder, Ahmed Mamunul Huq, Atikur Rahman

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Abstract

Background: Cardiovascular disease, and ischemic heart disease (IHD), is a major cause of morbidity and mortality in the very elderly patients (>80 years) worldwide. These patients represent a rapidly growing cohort presenting for percutaneous coronary intervention (PCI), now constituting more than one in five patients treated with PCI in real-world practice. Furthermore, they often have greater ischemic burden than their younger counterparts, suggesting that they have greater scope of benefit from coronary revascularization therapy. The elderly usually has higher prevalence of co morbidities and more often experience complications during and after revascularization procedures. Our aim was to evaluate clinical outcomes of PCI in patients older than 80 years, compared to their younger counterparts. Materials and methods: From July 2017 to July 2018 we included 212 patients with IHD purposively in Cardiology department of National Institute of Cardiovascular Diseases undergone PCI who were divided into 2 groups according to age: e” 80 years (n = 74) and < 80 years (n = 138). Baseline clinical characteristics, indications for coronary intervention, in hospital outcomes were obtained. Study endpoint were Renal impairment, MI, LVF, emergency revascularization and death. Results: Very elderly patients were more frequently male (86%) and nonsmoker at present (41% vs. 63%, p=0.003), had higher prevalence of hypertension (60% vs. 50%, p<0.13), and more often presented with NSTEMI (54% vs. 23%, p<0.001). Elderly group had higher incidence of TVD and LM disease (36% vs. 26% and 9.5% vs. 2.9%, p=0.07) and more incidence of ostial (16.2% vs.5.1%,p=0.007) and calcified lesions (31.1% vs. 14.5%, p=0.004). Procedural success (TIMI III) were high in both groups, but still lower in the elderly as compared to younger group (95% vs. 97%, p=0.65). Very elderly patients had higher incidence of post PCI bleeding, CIN, MI, LVF and death (9.5% vs.6.1%, 8.2% vs.3.7%, 6.8% vs.5.8%, 9.5% vs. 5.1% and 5.4%vs.3.6%,p=0.07), whereas emergency revascularization were higher in younger group (5.4% vs. 6.5%, p=0.07). Conclusion: Very elderly patients aged ≥80 years face more vascular site complications during PCI, usually have more LM and TVD with more ostial and calcified lesions in comparison with younger group. Though procedural success is similar with younger group, they face more post PCI CIN, LVF and MI. Repeat revascularization was higher in younger group. Bangladesh Heart Journal 2020; 35(1) : 61-65

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心脏专科医院高龄缺血性心脏病患者经皮冠状动脉介入治疗的住院疗效

背景:心血管疾病和缺血性心脏病(IHD)是世界范围内高龄患者(>80岁)发病率和死亡率的主要原因。这些患者代表了一个快速增长的接受经皮冠状动脉介入治疗(PCI)的人群，现在在现实世界中，超过五分之一的患者接受了PCI治疗。此外，他们往往比年轻人有更大的缺血负担，这表明他们从冠状动脉血运重建治疗中获益的范围更大。老年人通常有较高的合并症患病率，并且在血运重建术期间和之后更常出现并发症。我们的目的是评估80岁以上患者PCI的临床效果，并与年轻患者进行比较。材料与方法:2017年7月至2018年7月，我们在国立心血管疾病研究所心内科接受PCI治疗的IHD患者212例，按年龄分为80岁(n = 74)和80岁以下(n = 138)两组。获得基线临床特征、冠状动脉介入治疗指征和住院结果。研究终点为肾功能损害、心肌梗死、左心室充血、急诊血运重建术和死亡。结果:高龄患者多为男性(86%)，目前不吸烟(41%比63%，p=0.003)，高血压患病率较高(60%比50%，p<0.13)，更常出现NSTEMI(54%比23%，p<0.001)。老年组TVD、LM病变发生率较高(36% vs. 26%， 9.5% vs. 2.9%， p=0.07)，口部病变发生率较高(16.2% vs.5.1%，p=0.007)、钙化病变发生率较高(31.1% vs. 14.5%， p=0.004)。两组的手术成功率(TIMI III)都很高，但与年轻组相比，老年人的手术成功率仍较低(95%对97%，p=0.65)。高龄患者PCI术后出血、CIN、MI、LVF和死亡发生率较高(9.5%比6.1%、8.2%比3.7%、6.8%比5.8%、9.5%比5.1%和5.4%比3.6%，p=0.07)，而年轻患者急诊血运重建术发生率较高(5.4%比6.5%，p=0.07)。结论:≥80岁高龄患者行PCI时血管部位并发症较多，LM、TVD多，口部及钙化病变多。虽然手术成功率与年轻组相似，但他们面临更多的PCI后CIN、LVF和MI，重复血运重建率更高。孟加拉国心脏杂志2020;35(1): 61-65

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Bangladesh Heart Journal

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