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CTO PCI beneficial in elderly patients
The survival benefit associated with successful PCI of a chronic total occlusion in elderly patients was similar to that seen in younger patients, published data suggest.
Aurel Toma, MD, from the University Heart Center Freiburg-Bad Krozingen, Germany, and colleagues evaluated 2,002 consecutive patients — of whom 409 were older than 75 years — who underwent CTO PCI from 2005 to 2013. Successful CTO PCI was achieved in 75% of elderly patients.
During a median follow-up of 2.6 years, 238 patients overall died. All-cause mortality was higher among elderly patients vs. younger patients (26.7% vs. 8.3%; P < .001), which persisted after adjustment for baseline characteristics (adjusted HR = 1.98; 95% CI, 1.47-2.66).
Successful CTO PCI was associated with a significant survival benefit in both younger and elderly patients, according to the data. The absolute reduction in mortality before adjustment was numerically greater in elderly vs. younger patients (22.1% vs. 7.2% at 3 years). After multivariable adjustment, successful PCI CTO remained associated with lower rates of all-cause mortality in elderly (aHR = 0.58; 95% CI, 0.39-0.87) and younger patients (aHR = 0.59; 95% CI, 0.4-0.86).
Compared with younger patients, elderly patients had higher rates of MACE, defined as the composite of all-cause death, nonfatal MI and target vessel revascularization (39.6% vs. 28.6%; P < .001), the combined endpoint of all-cause death and MI (31.3% vs. 10.9%; P < .001) and TVR (12.7% vs. 20%; P < .001). The adjusted incidence of MACE, however, was similar for elderly and younger patients (aHR = 1.15; 95% CI, 0.93-1.41). Additionally, successful CTO PCI was associated with significantly reduced MACE in younger patients (aHR = 0.7; 95% CI, 0.55-0.88) but not in elderly patients (aHR = 0.84; 95% CI, 0.59-1.2).
In-hospital MACE rates were low and did not differ significantly between age groups, according to the researchers.
“This study demonstrates a similar survival benefit in elderly ( 75 years) as compared to younger patients after successful CTO PCI in the contemporary [drug-eluting stent] era, with comparable low rates of procedural complications and adverse in-hospital events,” the researchers wrote. “These findings strongly suggest that CTO PCI, when indicated, should not be withheld from the elderly patient population.” – by Melissa Foster
Disclosures: The authors report no relevant financial disclosures.