Coronary Revascularization Outcomes Have Improved in Elderly Patients

A multicenter analysis of data from more than 200,000 adults who underwent percutaneous coronary intervention or coronary artery bypass grafting shows that over the last decade the use of these techniques in elderly patients has increased and their outcomes have improved.

The findings are reported in the September issue of the American Heart Journal by Dr. Eric D. Peterson of the Duke Clinical Research Institute in Durham, North Carolina, and colleagues.

Fourteen registries containing information on 48,439 patients treated with percutaneous coronary intervention and eight registries with data for 180,709 patients treated with surgical revascularization were reviewed. The researchers identified patients who were 75 years old or older.

Between 1991 and 1999, the proportion of elderly patients who underwent revascularization rose by 10%. “Mortality rates declined significantly in older patients for both percutaneous coronary intervention and coronary artery bypass grafting over this decade,” the researchers report.

The authors also found that the risk of in-hospital death associated with revascularization procedures rose by approximately 1% per decade of life for percutaneous intervention, and by approximately 2% per decade of life for surgical intervention.

“Between the ages of 75 and 85 years, this gradual increase in risks is not prohibitive for considering these procedures as viable treatment options,” the investigators write. But, they caution, “This rate then exponentially increases beyond the age of 85.”

As in previous studies, risks of death and nonfatal complications were both lower after percutaneous coronary intervention than after surgical revascularization. Specifically, the risk of death was 3% after percutaneous angioplasty vs. 5.9% after surgery, and the risk of stroke was 0.4% after angioplasty vs. 3.5% after surgery.

“More than age, process and acuity variables are powerful predictors of risk,” the researchers write. “While age remains a determinant of procedural risk, this risk varies markedly among elderly patients, emphasizing the need for individualized risk assessments.”