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

• Published in: European heart journal. Acute cardiovascular care Vol. 9; no. 5; pp. 480 - 487
• Main Authors: Völz, Sebastian, Petursson, Petur, Angerås, Oskar, Odenstedt, Jacob, Ioanes, Dan, Haraldsson, Inger, Dworeck, Christian, Hirlekar, Geir, Redfors, Björn, Myredal, Anna, Libungan, Berglind, Albertsson, Per, Råmunddal, Truls, Omerovic, Elmir
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.08.2020
• Subjects: Aged, 80 and over; Cardiac and Cardiovascular Systems; Denmark - epidemiology; Female; Humans; Kardiologi; 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; Denmark; percutaneous coronary intervention; acute coronary syndrome; long-term follow-up; unstable angina; non-ST elevation myocardial infarction; octogenarian; nonagenarian restenosis; non-ST elevation acute coronary syndromes
• ISSN: 2048-8726; 2048-8734; 2048-8734
• DOI: 10.1177/2048872619877287

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.