High Risk Percutaneous Coronary Intervention in Octogenarians

Background:
The procedural risks of high risk percutaneous coronary intervention (HRPCI) using mechanical circulatory support (MCS) for octogenarians have not been well established. We sought to study the outcome of octogenarians (>80 years) undergoing HRPCI with MCS compared with those who are <80 years old.

Methods:
Using the cVAD Registry, we identified a total of 1,273 complex high-risk indicated patients who underwent PCI with MCS using Impella 2.5 or Impella CP. Patients without cardiogenic shock who underwent elective or urgent intervention were included. A total of 259 (20.2%) were octogenarians and 1,014 (79.6%) were <80 years old.

Results:
Octogenarians were older (84±3 vs. 65±8, p<0.001), had less diabetes (39% vs. 55%, p<0.001), higher mean STS score (9.1±8 vs. 4.6±6, P<0.001) and higher baseline ejection fraction (35±116 vs. 27±15, P<0.001). Despite a higher mean STS score, octogenarians had no difference in in-hospital mortality, stroke, myocardial infarction or need for recurrent revascularization compared with non-octogenarians (p value insignificant for all comparisons). Ejection fraction improved in both octogenarians and younger patients at the time of discharge (28% to 32% and 31% to 38%, respectively, p<0.0001) as well as NYHA class post PCI (NYHA Class III/IV 73% to 50% in octogenarians and younger patients, p<0.001). Freedom from death and major adverse cardiac and cerebrovascular events 30 days follow up, was similar as well in octogenarians and younger patients.

Conclusions:
The use of percutaneous circulatory support for HRPCI is reasonable and feasible in a selected octogenarian population with similar outcomes as those of younger selected patients. Irrespective of age, the use of Impella was an independent predictor of favorable outcomes.