Long Term Following Up Study In Very Elderly Patients With Selectived Percutaneous Coronary Interventions

Background:Coronary artery disease is becoming a major threat to human health for its high incidence and high mortality. In the circumstance of a global aging population, it is of great significance to conduct a research on the occurrence, development and treatment of the coronary artery disease. With the rennovationof the materials and technologies in coronary intervention, more and more elderly patients with coronary artery disease are treated by coronary intervention. Recently, PCI has been proven by many foreign studies to be safer and more effective in the elderly patients with a high success rate, fewer complications and quicker recovery when comparing with coronary artery bypass grafting. Foreign researches on the interventional treatment of the very elderly are increasing, while domestic researches are still inadequate. In addition, elderly patients are often excluded from interventional treatments in many coronary intervention randomized clinical studies on coronary artery disease. Therefore, the research on the intervention of elderly patients with coronary artery disease has both important clinical and social value.Objective:This study aims to investigate the risk factors affecting the long term outcome of patients over age 80 (very elderly age group), who underwent elective percutaneous coronary interventions (PCI).Method:This study retrospectively reviewed data from 433 patients who underwent percutaneous coronary intervention at Huashan hospital between January 2005 and September 2008. Medical histories, detailed baseline data such as gender, age, hypertension, hyperlipidemia, diabetes, as well as the results of coronary angiography, revascularization strategy, and stent numbers were gathered. The long-term major cardiovascular events and non-cardiovascular clinical events were followed up by telephones and outpatient clinic followup.Result:Very elderly group had more prevalence of hypertension than the elderly controls (76.85% VS 67.08%, P=0.061). There were no statistically significant differences in gender, smoking, unstable angina, diabetes, hyperlipidemia, renal dysfunction between two groups. The coronary lesions in angiography results including LM, LAD, LCX and RCA had no statistically significant difference as well. Very elderly group had lower percentage of single-vessel disease than the elderly controls (12.96% VS 24.31% P=0.013). Very elderly group tended to have high percentage of dual-vessel disease (31.48% VS 29.85% P=0.749) and tri-vessel disease (55.56% VS 45.85% P=0.081), although these differences had no statistical meaning. More stents were implanted in the very elderly group(2.23±1.14 VS 1.94±1.07 P=0.19) but it had no significant difference. The complete revascularization rate in very elderly age group was obviously less than the elderly control (43.01% VS 59.30% P=0.005).The duration of follow-up time between two groups was different. (909±431days VS 1009±376 days, P=0.122). Meanwhile, the difference of the endpoints included all-cause mortality (21.29% VS 6.15% P<0.001), cardiovascular mortality (16.67% VS 4.01% P<0.001), heart failure hospitalization (6.56%VS 2.77% P<0.001), angina hospitalization (33.33% VS 18.15% P<0.001), all cardiovascular causes of hospitalization (50.93%VS 27.08% P<0.001) was statistically significant.Conclusion:1. It is safe for the very elderly patients to be performed elective coronary intervention.2. Complete revascularization for the very elderly patients had no negative effect on their long-term prognosis, which points out that simplified coronary intervention treatment may also be beneficial.3. The very elderly group had higher risk of major adverse cardiac events than the elderly controls, and we found hypertension, old myocardial infarction, chronic kidney dysfunction, chronic heart failure, unstable angina also indicated poor long-term prognosis by stepwise regression.