Tokarek Tomasz, Siudak Zbigniew, Dziewierz Artur, Rakowski Tomasz, Krycińska Róża, Siwiec Andżelika, Dudek Dariusz
2nd Department of Cardiology and Cardiovascular Interventions, University Hospital.
Faculty of Medicine and Health Sciences, Jan Kochanowski University, Kielce, Poland.
Coron Artery Dis. 2018 Nov;29(7):573-578. doi: 10.1097/MCA.0000000000000649.
Despite an increase in the proportion of nonagenarians in demographic structure, there is still a paucity of data on the utilization and outcome of percutaneous coronary interventions (PCIs) in this population. Also, very old patients are under-represented in randomized clinical trials and their treatment is still an emerging challenge. Thus, we sought to compare patient profiles and periprocedural outcomes of PCI in nonagenarians and patients younger than 90 years.
Data were based on the Polish National Registry of PCI (ORPKI). A total of 651 080 consecutive patients with stable angina (SA) (n=260 920) or acute coronary syndrome (ACS) (n=390 160) undergoing PCI with at least one stent implanted were included. Patients were stratified according to age (<90 and ≥90 years).
Of all included patients, 4413 (0.7%) were older than or equal to 90 years. A similar rate of periprocedural complications was observed in both groups. However, cardiac arrest during both angiography and PCI occurred more often in nonagenarians (0.21 vs. 0.83%; 0.42 vs. 1.07%, respectively, for both P=0.001). Similarly, periprocedural mortality was higher in patients older than or equal to 90 years (0.27 vs. 1.88%; P=0.001). There were no differences in periprocedural outcomes between groups in the SA setting. However, a higher rate of periprocedural cardiac arrest [1971 (0.51%) vs. 43 (1.15%); P=0.001] and mortality [1622 (0.42%) vs. 83 (2.2%); P=0.001] were observed in nonagenarians compared with younger counterparts admitted with ACS.
Nonagenarians undergoing PCI because of SA may have similar outcomes as patients younger than 90 years. In ACS presentation, they may have worse outcomes than younger counterparts.
尽管人口结构中九旬老人的比例有所增加，但关于该人群经皮冠状动脉介入治疗（PCI）的使用情况和治疗结果的数据仍然匮乏。此外，年龄非常大的患者在随机临床试验中的代表性不足，对他们的治疗仍然是一个新出现的挑战。因此，我们试图比较九旬老人与90岁以下患者PCI的患者特征和围手术期结果。
数据基于波兰国家PCI注册中心（ORPKI）。总共纳入了651080例连续接受PCI且至少植入一枚支架的稳定型心绞痛（SA）患者（n = 260920）或急性冠状动脉综合征（ACS）患者（n = 390160）。患者根据年龄（<90岁和≥90岁）进行分层。
在所有纳入的患者中，4413例（0.7%）年龄大于或等于90岁。两组观察到的围手术期并发症发生率相似。然而，血管造影和PCI期间心脏骤停在九旬老人中更常发生（分别为0.21%对0.83%；0.42%对1.07%，P均=0.001）。同样，年龄大于或等于90岁的患者围手术期死亡率更高（0.27%对1.88%；P = 0.001）。在SA情况下，两组围手术期结果没有差异。然而，与因ACS入院的年轻患者相比，九旬老人围手术期心脏骤停发生率更高[1971例（0.51%）对43例（1.15%）；P = 0.001]和死亡率更高[1622例（0.42%）对83例（2.2%）；P = 0.001]。
因SA接受PCI的九旬老人可能与90岁以下患者有相似的结果。在ACS表现中，他们的结果可能比年轻患者更差。
