Octogenarians have been under-represented in percutaneous coronary intervention (PCI)
trials despite an increase in referrals for PCI. As the United States population ages,
the number of high-risk PCIs in the elderly will continue to increase. This study
investigated the effect of age on short-term prognosis after PCI in 3 age groups.
Using the 2000/2001 New York State Angioplasty Registry, we compared in-hospital mortality
and major adverse cardiac events (MACEs; death, stroke, or coronary artery bypass
grafting) in emergency and elective PCI cohorts across 3 age categories of patients:
10,964 patients who underwent emergency PCI (<60 years of age, n = 5,354; 60 to 80
years of age, n = 4,939; >80 years of age, n = 671) and 71,176 patients who underwent
elective PCI (<60 years of age, n = 24,525; 60 to 80 years of age, n = 40,869; >80
years of age, n = 5,782). Patients were considered to have undergone an emergency
PCI if they had an acute myocardial infarction within 24 hours, had thrombolytic therapy
within 7 days, or presented with hemodynamic instability or shock. Elderly patients
had more co-morbidities, including more extensive coronary atherosclerosis, hypertension,
peripheral vascular disease, and renal insufficiency, and presented more frequently
with hemodynamic instability or shock. In the emergency PCI group, in-hospital mortality
(1.0% vs 4.1% vs 11.5%, p <0.05) and MACEs (1.6% vs 5.2% vs 13.1%, p <0.05) increased
incrementally by age group. In the elective PCI group, rates of in-hospital complications
were considerably lower, with an incremental increase in mortality (0.1% vs 0.4% vs
1.1%, p <0.05) and MACEs (0.4% vs 0.7% vs 1.6%, p <0.05). Age was strongly predictive
of in-hospital mortality for emergency and elective PCI by multivariate analysis.
In conclusion, elective PCI in the elderly has favorable outcome and acceptable short-term
mortality in the stent era. Elderly patients, in particular octogenarians undergoing
emergency PCI, have a substantially higher risk of in-hospital death.