People in their nineties and older represent a tiny but growing fraction of patients who undergo percutaneous coronary intervention (PCI), new research shows.
Although the rate of death after PCI is higher for these nonagenarians than it is for younger patients, the benefits can outweigh the risks for some, Dr. Abhishek Sawant of the State University of New York at Buffalo and colleagues found.
“We did show that patients who had lower risk and underwent this procedure actually did very well,” Dr. Sawant told Reuters Health in a telephone interview.
To better understand the risks and benefits associated with PCI in older patients, Dr. Sawant and his colleagues looked at medical data from the U.S. Department of Veterans Affairs on more than 67,000 veterans who underwent PCI between 2005 and 2014. Overall, nonagenarians represented 0.4 percent of the group, but that proportion increased from 0.25 percent in 2008 to 0.58 percent in 2014.
Thirty days after the procedure, 10.6 percent of the nonagenarians had died, compared to 1.4 percent of the younger patients. Mortality one year after PCI was 16.3 percent versus 4.2 percent, according to the results published July 10 in JACC: Cardiovascular Interventions.
After the researchers took factors such as patients’ other health problems into account, they found that the nonagenarians were still about twice as likely to die within 30 days of PCI, and their one-year mortality was also roughly doubled compared to younger patients.
Dr. Sawant’s team also found they could predict mortality among the nonagenarians based on the patient’s National Cardiovascular Data Registry (NCDR) CathPCI score, which is a risk-assessment tool widely used on people undergoing PCI but had not previously been shown effective among people 90 and older.
Rather than rejecting a candidate for PCI out of hand based on age, Dr. Sawant said, physicians can use the NCDR CathPCI score to assess an individual’s risks, and then discuss these risks and potential benefits with the patient and his or her family. In these very old patients, he noted, PCI may not substantially extend life, but by easing chest pain, it can make important differences in their quality of life.
One caution about the study findings, the researcher noted, is that almost all the study participants were male – and the great majority of nonagenarians are female.
Another limitation of the study is that the “excellent” results of PCI in this over-90 population were not compared to similar patients who didn’t get PCI, writes Dr. David Holmes of the Mayo Clinic in Rochester, Minnesota, in an editorial accompanying the study. Still, the study provides valuable information for doctors looking to “optimize” longer-term treatment for these patients, he writes.