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Adverse clinical events after percutaneous coronary intervention in very elderly patients with acute coronary syndrome

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Abstract

The number of very elderly patients with acute coronary syndrome (ACS) is increasing. Therefore, owing to the need for evidence-based treatment decisions in this population, this study aimed to examine the clinical outcomes during 1 year after percutaneous coronary intervention (PCI) in very elderly patients with ACS. This prospective multicenter observational study comprised 1337 patients with ACS treated with PCI, classified into the following four groups according to age: under 60, <60 years; sexagenarian, ≥60 and <69 years; septuagenarian, ≥70 and <80 years; and very elderly, ≥80 years. The primary endpoint was a composite of the first occurrence of all-cause death, nonfatal myocardial infarction, nonfatal stroke, and bleeding within 1 year after PCI. We used the sexagenarian group as a reference and compared outcomes with those of the other groups. The incidence of the primary endpoint was significantly higher in the very elderly group than in the sexagenarian group (36 [12.7%] vs. 24 [6.9%], respectively; hazard ratio, 1.94; 95% confidence interval: 1.16–3.26; p = 0.012). The higher incidence of the primary endpoint was primarily driven by a higher incidence of all-cause death. When the multivariable analysis was used to adjust for patient characteristics and comorbidities, no difference was observed in the primary endpoint between the very elderly and sexagenarian groups (p = 0.96). The incidence of adverse events after PCI, particularly all-cause death, in very elderly patients with ACS was high. However, if several confounders are adjusted, comparable outcomes may be expected within 1 year after PCI among this population.

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Data availability

Data supporting the findings of this study are available through the corresponding author upon request. The data are not publicly available because of privacy and ethical restrictions.

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Acknowledgements

We thank the TWINCRE participants, investigators, and administrative staff of the TWINCRE study for their contributions.

Funding

No additional financial support was provided for the current study.

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Author notes

  1. Takanori Kawamoto and Hisao Otsuki have contributed equally as the first authors of this work.

Authors and Affiliations

  1. Department of Cardiology, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan

    Takanori Kawamoto, Hisao Otsuki, Hiroyuki Arashi & Junichi Yamaguchi

  2. Department of Cardiology, Tokyo Women’s Medical University Adachi Medical Center, Tokyo, Japan

    Kentaro Jujo

  3. Department of Cardiology, Saitama Medical Center, Saitama, Japan

    Kentaro Jujo

  4. Department of Cardiology, Nishiarai Heart Center, Tokyo, Japan

    Kentaro Jujo

  5. Department of Cardiology, Seirei Hamamatsu General Hospital, Shizuoka, Japan

    Toshiaki Oka

  6. Department of Cardiology, National Hospital Organization Yokohama Medical Center, Kanagawa, Japan

    Fumiaki Mori

  7. Department of Cardiology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan

    Hiroyuki Tanaka

  8. Department of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto, Japan

    Tomohiro Sakamoto

  9. Department of Cardiology, Ogikubo Hospital, Tokyo, Japan

    Yasuhiro Ishii

  10. Department of Cardiology, Saiseikai Kazo Hospital, Saitama, Japan

    Yutaka Terajima

  11. Department of Cardiology, Cardiovascular Center of Sendai, Miyagi, Japan

    Masahiro Yagi

  12. Department of Cardiology, Saiseikai Kawaguchi Hospital, Saitama, Japan

    Atsushi Takagi

  13. Department of Cardiology, Tokyo Women’s Medical University Yachiyo Medical Center, Tokyo, Japan

    Shoji Haruta

Authors
  1. Takanori Kawamoto
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  2. Hisao Otsuki
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  3. Hiroyuki Arashi
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  4. Kentaro Jujo
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  5. Toshiaki Oka
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  6. Fumiaki Mori
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  7. Hiroyuki Tanaka
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  8. Tomohiro Sakamoto
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  9. Yasuhiro Ishii
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  11. Masahiro Yagi
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  12. Atsushi Takagi
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  13. Shoji Haruta
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  14. Junichi Yamaguchi
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Contributions

HA, HO, KJ, and JY conceptualized and designed the original study. RS, MF, HT, TS, YI, YT, KY, AT, and SH collected the data and enrolled and followed up the patients. TK, HO, and HA analyzed and interpreted the data. TK, HO, and HA drafted the manuscript. HO and JY reviewed the manuscript.

Corresponding author

Correspondence to Hiroyuki Arashi.

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Conflict of interest

H. Otsuki and H. Arashi are affiliated with the Clinical Research Division for Cardiovascular Catheter Intervention and is financially supported by donations from Abbott, Boston Scientific, Medtronic, and Terumo.

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Kawamoto, T., Otsuki, H., Arashi, H. et al. Adverse clinical events after percutaneous coronary intervention in very elderly patients with acute coronary syndrome. Cardiovasc Interv and Ther (2024). https://doi.org/10.1007/s12928-024-01020-6

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