Dae Yong Park, Jiun-Ruey Hu, Sean DeAngelo, Aviral Vij, Yasser Jamil, Golsa Babapour, Zafer Akman, Parsa Pazooki, Abdulla A Damluji, Jennifer Frampton DO, Darrick K Li, Michael G Nanna
{"title":"年龄与经皮冠状动脉介入治疗期间冠状动脉粥样硬化切除术后不良事件的关系。","authors":"Dae Yong Park, Jiun-Ruey Hu, Sean DeAngelo, Aviral Vij, Yasser Jamil, Golsa Babapour, Zafer Akman, Parsa Pazooki, Abdulla A Damluji, Jennifer Frampton DO, Darrick K Li, Michael G Nanna","doi":"10.26599/1671-5411.2025.05.007","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Coronary atherectomy is used to treat severely calcified coronary artery lesions which are more frequent with increasing age, but its impact in older adults has not been sufficiently examined.</p><p><strong>Methods: </strong>We compared adults ≥ 18 years old who underwent coronary atherectomy during inpatient PCI in 2016-2023 from the Vizient Clinical Data Base and compared outcomes in younger (< 65 years), youngest-old (65-74 years), middle-old (75-84 years), and oldest-old (≥ 85 years) adults. Primary outcome was in-hospital mortality, and secondary outcomes included postprocedural complications.</p><p><strong>Results: </strong>Among 47,337 patients who underwent coronary atherectomy, 19,862 (42.0%) were younger adults and 27,475 (58.0%) were older adults, including 13,583 youngest-old, 10,206 middle-old, and 3,686 oldest-old adults. Compared with younger adults, youngest-old adults had higher mortality (adjusted odds ratio [aOR] = 1.37, <i>P</i> < 0.001), ischemic stroke (aOR = 1.35, <i>P</i> = 0.005), gastrointestinal hemorrhage (GIH) (aOR = 1.44, <i>P</i> < 0.001), acute kidney injury (AKI) (aOR = 1.43, <i>P</i> < 0.001), tamponade (aOR = 1.86, <i>P</i> < 0.001), and pericardiocentesis (aOR = 2.32, <i>P</i> < 0.001). Middle-old adults had higher mortality (aOR = 1.80, <i>P</i> < 0.001), GIH (aOR = 1.42, <i>P</i> = 0.002), AKI (aOR = 1.63, <i>P</i> < 0.001), tamponade (aOR = 2.52, <i>P</i> < 0.001), and pericardiocentesis (aOR = 3.13, <i>P</i> < 0.001). Oldest-old adults had the highest odds for mortality (aOR = 2.03, <i>P</i> < 0.001), GIH (aOR = 1.48, <i>P</i> = 0.016), AKI (aOR = 2.26, <i>P</i> < 0.001), tamponade (aOR = 3.86, <i>P</i> < 0.001), and pericardiocentesis (aOR = 4.21, <i>P</i> < 0.001). There was a significant interaction (P-interaction=0.035) between atherectomy and age groups with regard to the odds of in-hospital mortality.</p><p><strong>Conclusions: </strong>In this large claims-based study, in-hospital mortality, GIH, AKI, tamponade, and pericardiocentesis were higher in older adults compared with younger adults, in a stepwise manner by age group.</p>","PeriodicalId":51294,"journal":{"name":"Journal of Geriatric Cardiology","volume":"22 5","pages":"497-505"},"PeriodicalIF":2.6000,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12209150/pdf/","citationCount":"0","resultStr":"{\"title\":\"Association of age with adverse events following coronary atherectomy during percutaneous coronary intervention.\",\"authors\":\"Dae Yong Park, Jiun-Ruey Hu, Sean DeAngelo, Aviral Vij, Yasser Jamil, Golsa Babapour, Zafer Akman, Parsa Pazooki, Abdulla A Damluji, Jennifer Frampton DO, Darrick K Li, Michael G Nanna\",\"doi\":\"10.26599/1671-5411.2025.05.007\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Coronary atherectomy is used to treat severely calcified coronary artery lesions which are more frequent with increasing age, but its impact in older adults has not been sufficiently examined.</p><p><strong>Methods: </strong>We compared adults ≥ 18 years old who underwent coronary atherectomy during inpatient PCI in 2016-2023 from the Vizient Clinical Data Base and compared outcomes in younger (< 65 years), youngest-old (65-74 years), middle-old (75-84 years), and oldest-old (≥ 85 years) adults. Primary outcome was in-hospital mortality, and secondary outcomes included postprocedural complications.</p><p><strong>Results: </strong>Among 47,337 patients who underwent coronary atherectomy, 19,862 (42.0%) were younger adults and 27,475 (58.0%) were older adults, including 13,583 youngest-old, 10,206 middle-old, and 3,686 oldest-old adults. Compared with younger adults, youngest-old adults had higher mortality (adjusted odds ratio [aOR] = 1.37, <i>P</i> < 0.001), ischemic stroke (aOR = 1.35, <i>P</i> = 0.005), gastrointestinal hemorrhage (GIH) (aOR = 1.44, <i>P</i> < 0.001), acute kidney injury (AKI) (aOR = 1.43, <i>P</i> < 0.001), tamponade (aOR = 1.86, <i>P</i> < 0.001), and pericardiocentesis (aOR = 2.32, <i>P</i> < 0.001). Middle-old adults had higher mortality (aOR = 1.80, <i>P</i> < 0.001), GIH (aOR = 1.42, <i>P</i> = 0.002), AKI (aOR = 1.63, <i>P</i> < 0.001), tamponade (aOR = 2.52, <i>P</i> < 0.001), and pericardiocentesis (aOR = 3.13, <i>P</i> < 0.001). Oldest-old adults had the highest odds for mortality (aOR = 2.03, <i>P</i> < 0.001), GIH (aOR = 1.48, <i>P</i> = 0.016), AKI (aOR = 2.26, <i>P</i> < 0.001), tamponade (aOR = 3.86, <i>P</i> < 0.001), and pericardiocentesis (aOR = 4.21, <i>P</i> < 0.001). There was a significant interaction (P-interaction=0.035) between atherectomy and age groups with regard to the odds of in-hospital mortality.</p><p><strong>Conclusions: </strong>In this large claims-based study, in-hospital mortality, GIH, AKI, tamponade, and pericardiocentesis were higher in older adults compared with younger adults, in a stepwise manner by age group.</p>\",\"PeriodicalId\":51294,\"journal\":{\"name\":\"Journal of Geriatric Cardiology\",\"volume\":\"22 5\",\"pages\":\"497-505\"},\"PeriodicalIF\":2.6000,\"publicationDate\":\"2025-05-28\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12209150/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Geriatric Cardiology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.26599/1671-5411.2025.05.007\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Geriatric Cardiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.26599/1671-5411.2025.05.007","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
摘要
背景：冠状动脉粥样硬化切除术用于治疗严重钙化的冠状动脉病变，随着年龄的增长，这种病变更常见，但其对老年人的影响尚未得到充分的研究。方法：我们比较了来自Vizient临床数据库的2016-2023年住院PCI期间接受冠状动脉粥样硬化切除术的≥18岁的成年人，并比较了年轻（< 65岁）、最年轻（65-74岁）、中年（75-84岁）和老年（≥85岁）成年人的结局。主要结局是住院死亡率，次要结局包括术后并发症。结果：在47337例接受冠状动脉粥样硬化切除术的患者中，19862例（42.0%）为年轻人，27475例（58.0%）为老年人，其中青年人13583例，中年人10206例，老年人3686例。与年轻人相比，最年轻-老年人的死亡率（校正优势比[aOR] = 1.37, P < 0.001）、缺血性卒中（aOR = 1.35, P = 0.005）、胃肠出血（aOR = 1.44, P < 0.001）、急性肾损伤（aOR = 1.43, P < 0.001）、心包填塞（aOR = 1.86, P < 0.001）和心包穿刺（aOR = 2.32, P < 0.001）较高。中老年成人死亡率较高（aOR = 1.80, P < 0.001）、GIH （aOR = 1.42, P = 0.002）、AKI （aOR = 1.63, P < 0.001）、心包填塞（aOR = 2.52, P < 0.001）、心包穿刺（aOR = 3.13, P < 0.001）。高龄老年人的死亡率最高（aOR = 2.03, P < 0.001）、GIH （aOR = 1.48, P = 0.016）、AKI （aOR = 2.26, P < 0.001）、心包填塞（aOR = 3.86, P < 0.001）和心包穿刺（aOR = 4.21, P < 0.001）。在住院死亡率方面，动脉粥样硬化切除术和年龄组之间存在显著的相互作用（p -相互作用=0.035）。结论：在这项基于索赔的大型研究中，与年轻人相比，老年人的住院死亡率、GIH、AKI、心包填塞和心包穿刺更高，并按年龄组逐步划分。
Association of age with adverse events following coronary atherectomy during percutaneous coronary intervention.
Background: Coronary atherectomy is used to treat severely calcified coronary artery lesions which are more frequent with increasing age, but its impact in older adults has not been sufficiently examined.
Methods: We compared adults ≥ 18 years old who underwent coronary atherectomy during inpatient PCI in 2016-2023 from the Vizient Clinical Data Base and compared outcomes in younger (< 65 years), youngest-old (65-74 years), middle-old (75-84 years), and oldest-old (≥ 85 years) adults. Primary outcome was in-hospital mortality, and secondary outcomes included postprocedural complications.
Results: Among 47,337 patients who underwent coronary atherectomy, 19,862 (42.0%) were younger adults and 27,475 (58.0%) were older adults, including 13,583 youngest-old, 10,206 middle-old, and 3,686 oldest-old adults. Compared with younger adults, youngest-old adults had higher mortality (adjusted odds ratio [aOR] = 1.37, P < 0.001), ischemic stroke (aOR = 1.35, P = 0.005), gastrointestinal hemorrhage (GIH) (aOR = 1.44, P < 0.001), acute kidney injury (AKI) (aOR = 1.43, P < 0.001), tamponade (aOR = 1.86, P < 0.001), and pericardiocentesis (aOR = 2.32, P < 0.001). Middle-old adults had higher mortality (aOR = 1.80, P < 0.001), GIH (aOR = 1.42, P = 0.002), AKI (aOR = 1.63, P < 0.001), tamponade (aOR = 2.52, P < 0.001), and pericardiocentesis (aOR = 3.13, P < 0.001). Oldest-old adults had the highest odds for mortality (aOR = 2.03, P < 0.001), GIH (aOR = 1.48, P = 0.016), AKI (aOR = 2.26, P < 0.001), tamponade (aOR = 3.86, P < 0.001), and pericardiocentesis (aOR = 4.21, P < 0.001). There was a significant interaction (P-interaction=0.035) between atherectomy and age groups with regard to the odds of in-hospital mortality.
Conclusions: In this large claims-based study, in-hospital mortality, GIH, AKI, tamponade, and pericardiocentesis were higher in older adults compared with younger adults, in a stepwise manner by age group.
期刊介绍：
JGC focuses on both basic research and clinical practice to the diagnosis and treatment of cardiovascular disease in the aged people, especially those with concomitant disease of other major organ-systems, such as the lungs, the kidneys, liver, central nervous system, gastrointestinal tract or endocrinology, etc.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
