Strategy And Long-term Clinical And Angiographic Follow-up Results Of Percutaneous Coronary Intervention In Elderly Patients With Coronary Artery Disease

Background The number of eldly patients who receive the treatment ofpercutaneous coronary intervention (PCI) are enormously increasing due to thedevelopment of PCI technology. The lesions and operating characteristics, operationstrategy selection and prognosis has been paid more and more attention.Objectives (1) To discuss the relationship between the SYNTAX score and long-termoutcomes of percutaneous coronary intervention (PCI) in eldly patients with coronaryheart disease.(2) To observe the efficacy and safety of emergent PCI in eldly patientswith coronary heart disease.(3) To compare the influence of completerevascularization (CR) with incomplete revascularization (ICR) on long-term outcomesin eldly patients with multivessel coronary heart disease undergoing percutaneouscoronary intervention.Methods We carried out a retrospective analysis of the clinical data, lesion type, PCIdata, MACCE and long-term outcomes in305eldly patients with multivessel coronaryheart disease between February2005and December2009at our department.Grouping criteria:(1) The SYNTAX scores,（2）emergent PCI and selective PCI,(3)CR and ICR.Results In total,305eldly patients underwent PCI with complete clinical andfollow-up data were included in the study, of whom173(56.4%) were men and132(43.6%) were women. All patients were between75and87years of age (mean±SD78.66±3.12years).(1) The SYNTAX scores groups had no significant differences in long-term outcomes, Multiple factors analysis demonstrated that FBG, togetherwith Scr was linearly related to SYNTAX score (β=0.277，p=0.009;β=0.244, p=0.022).(2) In the55cases of emergent PCI, the incidence of in-hospital motality, hypotentionor bradycardia, hemorrhage and hospitalization time were significantly higher than theselective procedures (7.2%vs0.0%, p=0.005；14.3%vs8.1%, p=0.043；14.3%vs4.3%, p=0.049；16.74±11.49vs11.05±9.04, p=0.006). But there were no significantdifferences in MACCE and The clinical success (7.1%vs1.7%, p=0.168；81.4%vs88.9%, p=0.876).(3)247cases(91.8%) in269patients were completed the follow-up.The outcome after a mean follow-up of41.09±17.74months showed that death fromall causes30cases (11.9%), MACCE37cases(14.2%), including cardic death14cases(5.3%), non-fatal myocardial infarction4cases(1.8%), repeated PCI8cases(3.5%), cerebral apoplexy11cases(4.4%).There were no significant differencesin MACCE, cardic death and repeated PCI between CR group and ICR group. Coxregression analysis presented that arrythmia and chronic kidney disease impacted thelong-term life time prominently in PCI of the very eldly patients (OR=16.537,p=0.003,95%CI=2.473-110.592; OR=9.798, p=0.022,95%CI=1.404-68.398).Conclusions (1) The differences in long-term outcomes were not statisticallysignificant among the SYNTAX scores groups.(2) Although there was higher risk ateldly patients with coronary heart disease undergoing emergent PCI, the efficacy wasin the affirmative.(3) Based on the results of the study, long-term prognosis for ICRwas not inferior to that for CR in patients with multivessel coronary heart diseaseundergoing PCI.