PCI leads to high mortality in older adults

Older adults who undergo percutaneous coronary intervention (PCI) see excess rates of death 1 and 3 years after the procedure, reports a recent Singapore study.

Drawing from the online databases of PubMed, Embase, Scopus, and CENTRAL, the researchers assessed 132 eligible studies, yielding a cumulative study sample of 2,566,004 patients. Outcomes included all-cause death, cardiac death, in-hospital death, subsequent stroke, subsequent myocardial infarction (MI), subsequent congestive cardiac failure (CCF), and overall major adverse cardiac events (MACE).

Pooled analysis revealed a 19.22-percent overall cumulative incidence of all-cause death, while cardiac death occurred in 7.78 percent. Meanwhile, the rates for in-hospital death, subsequent stroke, and subsequent MI were 7.16 percent, 1.54 percent, and 3.58 percent, respectively. [AsiaIntervention 2022;8:123-131]

In addition, 4.74 percent developed subsequent CCF, while MACEs arose in 17.51 percent of patients.

Such risk aggravation worsened with prolonged follow-up. For instance, the incidence of all-cause death after PCI was 14.73 percent at 1 year in older adults and jumped to 33.27 percent by the 3-year follow-up. The same was true for cardiac death (5.95 percent to 22.81 percent), subsequent stroke (1.34 percent to 3.54 percent), MI (2.10 percent to 5.79 percent), and CCF (1.14 percent to 17.45 percent).

In contrast, the incidence of overall MACE dropped slightly from 15.23 percent at 1 year to 14.93 percent at 3 years.

“This high mortality rate was likely contributed to by the prevalence of underlying cardiovascular disease since most studies reported at least a 50-percent incidence of acute coronary syndrome,” the researchers explained.

“With the increasing burden of coronary artery disease, especially in senior patients aged 80 years old and above, more studies are required to study the implications of the high mortality rate at 1 year and 3 years post-PCI, regardless of indication,” they added.

Does STEMI matter?

In subsequent analysis, the researchers pooled 27 studies to come up with a cohort of 106,343 patients with ST segment-elevation MI (STEMI). In this subpopulation, 23.08 percent died of any cause, 9.42 percent died of cardiac causes, while 14.24 percent died while admitted in the hospital.

Subsequent stroke, MI, and CCF were documented in 1.93 percent, 3.68 percent, and 13.08 percent, respectively. MACE had a prevalence of 12.19 percent.

In comparison, non-STEMI patients saw better outcomes than their STEMI counterparts. In-hospital death, for instance, occurred in only 4.89 percent of the non-STEMI subpopulation (p<0.001). Subsequent stroke (0.12 percent; p<0.001) and MI (1.55 percent; p=0.039) were likewise significantly less likely to arise in non-STEMI patients.

“Overall, clinicians need to appreciate the high cumulative incidence of various clinical outcomes in senior patients who have undergone PCI, taking into consideration the patient’s quality of life and goals of care, and individualize the treatment regime where appropriate,” the researchers said.