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Percutaneous coronary interventions in octogenarians in the American College of Cardiology-National Cardiovascular Data Registry: development of a nomogram predictive of in-hospital mortality.
- Source :
-
Journal of the American College of Cardiology [J Am Coll Cardiol] 2002 Aug 07; Vol. 40 (3), pp. 394-402. - Publication Year :
- 2002
-
Abstract
- Objectives: We sought to evaluate the results of percutaneous coronary intervention (PCI) in elderly patients in contemporary practice.<br />Background: Prior studies of PCI in the elderly population demonstrate increased in-hospital mortality, but these studies are limited by small population size.<br />Methods: Using the American College of Cardiology-National Cardiovascular Data Registry (ACC-NCDR) of 100,253 patients, the in-hospital outcomes in all 8,828 PCI procedures performed on octogenarians were evaluated. Patients underwent PCI between 1998 and 2000 at over 145 participating centers.<br />Results: The mean age was 83.72 +/- 3.02 years, with female preponderance (53%). The PCI was considered angiographically successful in 93%, stents were placed in 75%, and the post-PCI length of stay was 3.3 +/- 5.1 days. Overall in-hospital mortality was 3.77% but was only 1.35% in PCI without recent myocardial infarction (MI) within one week (p < 0.0001). Patients having PCI within 6 h of the onset of their MI had an increase in mortality tenfold (13.79%) compared with patients without a recent MI (p < 0.0001). All groups that were defined based on time of PCI after MI onset up to seven days had increased mortality (all p < 0.0001). Older age (odds ratio [OR] of 1.03 per incremental year), depressed ejection fraction (EF) (OR 0.69 per 10 points for EF <60%), and time of PCI after MI onset (<6 h, OR 6.87; 6 to 24 h, OR 5.66; 24 h to one week, OR 2.93) were most strongly predictive of outcome by multivariate analysis. The predicted mortality from the multivariate model correlated well with the observed in-hospital mortality up to 20% mortality. A 254-point nomogram was constructed employing the logistic model using a weighted point system.<br />Conclusions: In patients > or = 80 years old, PCI has good success and acceptable mortality. The presence of an acute or recent MI substantially increases the risk of in-hospital death.
- Subjects :
- Age Factors
Aged
Angina, Unstable mortality
Angina, Unstable physiopathology
Angina, Unstable therapy
Coronary Artery Bypass
Female
Hospital Mortality
Humans
Incidence
Length of Stay
Male
Multivariate Analysis
Myocardial Infarction mortality
Myocardial Infarction physiopathology
Myocardial Infarction therapy
Predictive Value of Tests
Risk Factors
Sex Factors
Statistics as Topic
Stroke Volume physiology
Survival Analysis
Treatment Outcome
United States epidemiology
Aged, 80 and over
Angioplasty, Balloon, Coronary
Registries
Subjects
Details
- Language :
- English
- ISSN :
- 0735-1097
- Volume :
- 40
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Journal of the American College of Cardiology
- Publication Type :
- Academic Journal
- Accession number :
- 12142102
- Full Text :
- https://doi.org/10.1016/s0735-1097(02)01992-7