Saada Majdi, Kobo Ofer, Kauer Floris, Sakhov Orazbek, Laanmets Peep, Abhaichand Rajpal, Lozano Iñigo, Crowley Jim, Wander Gurupreet Singh, Mamas Mamas A, Roguin Ariel
Hillel Yaffe Medical Center, Technion-Faculty of Medicine, Israel.
Department of Cardiology, Albert Schweitzer Ziekenhuis, Dordrecht, the Netherlands.
J Soc Cardiovasc Angiogr Interv. 2022 Aug 24;1(5):100442. doi: 10.1016/j.jscai.2022.100442. eCollection 2022 Sep-Oct.
Older adult patients undergoing percutaneous coronary intervention (PCI) are usually excluded from clinical trials. This study aimed to assess 1-year clinical outcomes in patients aged >80 years.
This all-comer registry included patients who underwent PCI using the Ultimaster stent. Primary clinical endpoint was target lesion failure (TLF), a composite of cardiac death (CD), target vessel-related myocardial infarction (TV-MI), or clinically indicated target lesion revascularization (CD-TLR).
In total, 3286 (8.8%) patients aged ≥80 years were compared with 33,912 patients aged <80 years. The older adult patients included more women, had more comorbidities and exhibited more complex coronary anatomy. The incidence of TLF was higher in the older adult group (5.6% vs 3.0%, < .0001), as well as for all-cause mortality (6.2% vs 1.7%, < .0001), CD (3.3% vs 1.1%, < .0001), and TV-MI (1.7% vs 0.8%, < .0001), but not for CD-TLR (1.9% vs 1.7%, = .15). After the inverse propensity score weighted analysis, aged ≥80 years was associated with increased risk of TLF (HR, 1.42; 95% CI, 1.22-1.66; < .0001), CD (HR, 1.67; 95% CI, 1.136-2.06; < .0001), and TV-MI (HR, 1.66; 95% CI, 1.24-2.24; < .001) but not for CD-TLR (HR, 1.10; 95% CI, 0.85-1.43; = .45).
Older adult patients had a higher incidence of TLF, CD, and TV-MI but with no difference in the incidence of recurrent revascularization or stent thrombosis. Although PCI in older adults is relatively safe, higher rates of cardiac events should be considered.
接受经皮冠状动脉介入治疗（PCI）的老年患者通常被排除在临床试验之外。本研究旨在评估80岁以上患者的1年临床结局。
该全人群注册研究纳入了使用Ultimaster支架接受PCI的患者。主要临床终点是靶病变失败（TLF），这是一个由心源性死亡（CD）、靶血管相关心肌梗死（TV-MI）或临床指征的靶病变血运重建（CD-TLR）组成的复合终点。
总共将3286例（8.8%）年龄≥80岁的患者与33912例年龄<80岁的患者进行了比较。老年患者中女性更多，合并症更多，冠状动脉解剖结构更复杂。老年组的TLF发生率更高（5.6%对3.0%，P<0.0001），全因死亡率（6.2%对1.7%，P<0.0001）、CD（3.3%对1.1%，P<0.0001）和TV-MI（1.7%对0.8%，P<0.0001）也是如此，但CD-TLR发生率无差异（1.9%对1.7%，P=0.15）。在进行倾向评分逆加权分析后，年龄≥80岁与TLF风险增加相关（HR，1.42；95%CI，1.22-1.66；P<0.0001）、CD（HR，1.67；95%CI，1.136-2.06；P<0.0001）和TV-MI（HR，1.66；95%CI，1.24-2.24；P<0.001），但CD-TLR无差异（HR，1.10；95%CI，0.85-1.43；P=0.45）。
老年患者的TLF、CD和TV-MI发生率较高，但再次血运重建或支架血栓形成的发生率无差异。虽然老年患者的PCI相对安全，但应考虑较高的心脏事件发生率。
