Are the elderly different? Factors influencing mortality after percutaneous coronary intervention with stent implantation

• Published in: Zeitschrift für Gerontologie und Geriatrie Vol. 46; no. 2; pp. 144 - 150
• Main Authors: Schröder, J., Müller-Werdan, U., Reuter, S., Vogt, A., Schlitt, M., Raaz, U., Reindl, I., Buerke, M., Werdan, K., Schlitt, A.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01.02.2013
• Subjects: Adult; Age Distribution; Aged; Aged, 80 and over; Aging; Blood Vessel Prosthesis - statistics & numerical data; Coronary Artery Disease - mortality; Coronary Artery Disease - surgery; Female; Follow-Up Studies; Geriatrics/Gerontology; Germany - epidemiology; Humans; Internal Medicine; Male; Medicine; Medicine & Public Health; Middle Aged; Original Contribution; Percutaneous Coronary Intervention - mortality; Prevalence; Risk Assessment; Sex Distribution; Social Sciences; Stents - statistics & numerical data; Survival Analysis; Survival Rate; Treatment Outcome; Germany; Alter; Stent implantation; Risikofaktor; Mortality; Risk factor; Koronare Herzkrankheit; Stentimplantation; Elderly; Coronary heart disease; Mortalität
• ISSN: 0948-6704; 1435-1269
• DOI: 10.1007/s00391-012-0338-y

Background The aim of this study was to investigate factors influencing mortality after percutaneous coronary intervention (PCI) in patients aged ≥ 75 years compared to younger patients. Patients and methods A total of 1,809 coronary heart disease (CHD) patients after PCI with stent implantation in our hospital were assessed. Kaplan–Meier analyses with log-rank test and Cox regression analyses were performed on three predefined models concerning primary endpoint of all-cause mortality. Model 1 was a univariate analysis of the influence of age dichotomized by age 75 years on the primary endpoint. Model 2 included age and classical cardiovascular risk factors (CVRFs, e.g., body mass index (BMI), smoking, diabetes, and hypertension). Model 3 consisted of age, classical CVRFs, and additional factors (e.g., medication; hemoglobin, peripheral arterial disease (PAD), low-density lipoprotein cholesterol (LDL-C) and creatinine levels, and left ventricular ejection fraction (LVEF)). Results In the mean follow-up of 137 ± 61 weeks 375 patients died. Age ≥ 75 years was significantly related to mortality in all models. In model 3, previous stroke, PAD, diabetes, elevated levels of serum creatinine, and increased LDL-C were related to elevated mortality, higher hemoglobin levels, and LVEF > 50% were associated with decreased mortality in all patients and in patients < 75 years. In patients ≥ 75 years arterial hypertension was associated with poor outcome (hazard ratio (HR) 7.989, p = 0.040), previous antiplatelet therapy showed reduced mortality (HR 0.098, p = 0.039). Conclusion Although risk factors such as previous stroke, PAD, diabetes, renal insufficiency, and anemia were predictors for death in all patients and patients < 75 years, in the elderly only arterial hypertension increased, whereas treatment with platelet inhibitors decreased mortality.