Long-Term Clinical Outcomes of Percutaneous Coronary Intervention Using Drug-Eluting Stents in Octogenarians and Older

Sun Hwa Lee, Jei Keon Chae
2007 Korean Circulation Journal  
and Objectives: In this current era of using drug-eluting stents (DES), studies that demonstrate the feasibility and clinical outcome of percutaneous coronary intervention (PCI) using DES in a subset of extremely aged patients are lacking. We investigated the clinical characteristics, therapeutic and clinical outcomes of patients older than 80 years that had been implanted with DES during a PCI. Subjects and Methods: Fifty-three "octogenarian" patients (≥80-years-old) and 1036
more » ... 6 "non-octogenarian" patients (<80-years-old) that had been implanted with DES at Chonbuk National University Hospital since March 2003 were enrolled in the study. Medical records of the patients in the two groups were retrospectively reviewed. Results: The mean ages of the patients in the two groups were 83±2 years and 62±11 years, respectively, and the mean follow-up period was 15.8±10.9 months and 21.1±10.8 months, respectively. The octogenarian group showed an increased prevalence of female patients (58.5% vs. 35.1%, p=0.001), acute coronary syndrome (98.1% vs. 78.6%, p=0.001), ST-segment elevation myocardial infarction (41.5% vs. 28.3%, p=0.003), shock (17.0% vs. 6.6%, p=0.004), heart failure (22.6% vs. 9.3%, p=0.002) and a higher in-hospital major adverse cardiac event (MACE) rate (13.2% vs. 3.5%, p=0.004) than the non-octogenarian patients. Angiographic restenosis and target lesion revascularization rates were not different in both groups, but overall MACE (18.9% vs. 9.9%, p=0.035) and all-cause mortality (p<0.001) rates were significantly higher in the octogenarian group of patients. Conclusion: Although angiographic followup results were comparable in octogenarians and non-octogenarians, the occurrence of short-and long-term MACE was significantly higher in the very elderly group owing to a substantial subset of high-risk patients. (Korean Circ J 2007;37:647-655) KEY WORDS: Aged, 80 and over; Coronary disease; Stents. 서 론 고령화 사회가 되어 가면서 노인 인구에서 발생하는 관상 동맥 질환의 비중 또한 점차 증가하고 있다. 1-6) 고령에서 나타나는 허혈성 심질환은 젊은 연령보다 복잡 병변이나 불 안정 협심증의 비중이 크고, 좌심실 기능이 더 나쁘며, 동반 질환을 갖는 경우가 많고, 2)7-10) 이로 인해 경피적 관동맥 중 재시술 (percutaneous coronary intervention, PCI)이나 관 동맥 우회술 (coronary artery bypass graft, CABG)과 같 은 혈관 재개통술과 관련된 합병증의 발생률이나 사망률이 더 높은 것으로 알려져 있다. 2)3)7-12) 고령의 관동맥 질환 환 자에서도 침습적인 혈관 재개통술의 효과가 입증되어 있지
doi:10.4070/kcj.2007.37.12.647 fatcat:f2kizqamzjbc7ecztc3kgruhzq