Clin Res Cardiol 96:Suppl 2 (2007)

P357 - Angiography findings, clinical consequences and complications of coronary angiography/PCI in 13 889 very elderly patients (>= 80 years) compared to patients < 80 years of age.
B. von Wangenheim1, B. Lagerqvist2, U. Stenestrand3, I. Mueller1, J. Carlsson1
1Medicinsk klinik, Länssjukhuset, Kalmar, Schweden; 2Kardiologi, Akademiska sjukhuset, Uppsala, Schweden; 3Kardiologi, Hjärtcentrum, Linköping, Schweden;
Background: Lack of consensus regarding use of an invasive strategy in the very elderly with coronary artery disease has repeatedly been demonstrated. This is in part due to the fear of complications and to the assumption that nothing can be done in most of these cases because of advanced disease. At the same time, the number of these patients is increasing in western societies.
Methods: We have used a national database (SCAAR: Swedish Coronary Angiography and Angioplasty Registry) to determine angiography findings, clinical consequences and complications of coronary angiography/PCI in the very elderly (>= 80 years) compared to patients < 80 years of age in the years 2000-2005.
Results: See table. Age was even in multivariate analysis a predictor for outcome after invasive procedures.
Conclusions: Elderly patients had significantly more often 3-vessel disease, left main stem stenosis, and a higher proportion received invasive intervention (revascularization) after angiography compared to younger patients. Elderly patients undergoing PCI had more often STEMI as the indication, a higher rate of procedure-caused complications as well as a higher 30-day all-cause mortality, though these rates were by all means not excessive with respect to higher baseline risk. Only studies comparing invasively and non-invasively managed elderly patients can evaluate the net-benefit of invasive procedures in this patient cohort.
  >= 80 years < 80 years p-value
Coronary angiography all (n) 13 889 169 247 -
Normal/ no significant stenosis (%) 12.3 24.7 <0.001
3-vessel disease (%) 30.8 20.9 <0.001
Left main disease (%) 15.9 7.6 <0.001
PCI or heart surgery performed (%) 74.1 65.5 <0.001
Coronary angiography only (n) 7526 99 927 -
30-day mortality in angiography only patients (%) 4.8 1.2 <0.001
PCI performed (n) 6363 69 320 -
STEMI as indication for PCI (%) 25.0 17.6 <0.001
Bleeding/vascular complication to PCI (%) 5.1 2.9 <0.001
Stroke/TIA caused by PCI (%) 0.6 0.2 <0.001
30-day mortality in PCI patients (%) 6.9 1.6 <0.001