Background
Very elderly patients are largely under-represented in randomized clinical trials. We sought to evaluate the association between coronary chronic total occlusions (CTO) and adverse outcomes very elderly patients with stable ischemic heart disease (SIHD).
Methods
Retrospective study of patients
>80 years old with SIHD referred for invasive coronary angiography (ICA) at Kaiser Permanente Los Angeles Medical Center between April 2009 and February 2019. Patients were grouped on whether or not they had at least
>1 coronary CTO on ICA. Cox proportional hazard regression analysis was utilized to evaluate outcomes.
Results
A total of 1,017 patients (average age 83.6±2.9years, 29% female) were included. Of these, 467 (45.9%) patients had presence of at least
>1 CTO. The CTO group were more likely to be male (76% vs 67%, p=0.001), have left main disease (23% vs 15%, p<0.001), lower left ventricular ejection fraction (LVEF) (54.0±12.7 vs 58.6±12.2, p<0.001), have prior myocardial infarction (MI) (27% vs 15%, p<0.001), CABG (49% vs 8.7%, p<0.001), COPD (27% vs 21%, p=0.023), and have higher brain-natriuretic peptide (BNP) levels (389.7±559.7 vs 280.0±415.8pg/mL, p=0.006). At a median follow-up of 42.3 months (interquartile range 19.9-71.4 months), presence of at least
>1 CTO was independently associated with increased mortality (Hazard Ratio [HR] 1.45, 95% Confidence Interval [CI] 1.09-1.93, p=0.011) when adjusting for age, sex, race, diabetes, atrial fibrillation, LVEF, BNP, and renal function.
Conclusions
In very elderly patients with SIHD, presence of coronary CTOs is independently associated with increased mortality at long-term follow-up. Presence of CTOs may be reflective of the advanced cardiac risk profile of the individual. Further studies are needed to evaluate the benefits of CTO intervention in very elderly patients.