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Acute coronary syndrome in octogenarians: association between percutaneous coronary intervention and long-term mortality.

Barywani SB, Li S, Lindh M, Ekelund J, Petzold M, Albertsson P, Lund LH, Fu ML - Clin Interv Aging (2015)

Bottom Line: Cox regression analysis in overall cohort by adjustment for ten baseline variables showed statistically significant association between PCI and reduced long-term mortality (P<0.001, hazard ratio 0.4, 95% confidence interval [CI] 0.2-0.5).Furthermore, by performing Cox regression analysis, PCI was still associated with reduced long-term mortality (P=0.029, hazard ratio 0.5, 95% CI 0.3-0.9) after adjustment for PS and confounders: age, male sex, cognitive deterioration, uncured malignancies, left ventricular ejection fraction ≤45%, estimated glomerular filtration rate ≤35 mL/min, ST-segment elevation myocardial infarction, mitral regurgitation, and medication at discharge with clopidogrel and statins.In octogenarians with ACS, PCI was associated with improved survival from all-cause death over 5 years of follow-up.

View Article: PubMed Central - PubMed

Affiliation: Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Sahlgrenska University Hospital/Östra Hospital, Gothenburg, Sweden.

ABSTRACT

Aim: Evidence of improved survival after use of percutaneous coronary intervention (PCI) in elderly patients with acute coronary syndrome (ACS) is limited. We assessed the association between PCI and long-term mortality in octogenarians with ACS.

Methods and results: We followed 353 consecutive patients aged ≥80 years hospitalized with ACS during 2006-2007. Among them, 182 were treated with PCI, whereas 171 were not. PCI-treated patients were younger and more often male, and had less stroke and dependency in activities of daily living, but there were no significant differences in occurrence of diabetes mellitus, chronic obstructive pulmonary disease, hypertension, and uncured malignancies between the two groups. The association between PCI and all-cause mortality was assessed in the overall cohort and a 1:1 matched cohort based on propensity score (PS). In overall cohort, 5-year all-cause mortality was 46.2% and 89.5% in the PCI and non-PCI groups, respectively. Cox regression analysis in overall cohort by adjustment for ten baseline variables showed statistically significant association between PCI and reduced long-term mortality (P<0.001, hazard ratio 0.4, 95% confidence interval [CI] 0.2-0.5). In propensity-matched cohort, 5-year all-cause mortality was 54.9% and 83.1% in the PCI and non-PCI groups, respectively. Kaplan-Meier survival curves and log rank test showed significantly improved mean survival rates (P=0.001): 48 months (95% CI 41-54) for PCI-treated patients versus 35 months (95% CI 29-42) for non-PCI-treated patients. Furthermore, by performing Cox regression analysis, PCI was still associated with reduced long-term mortality (P=0.029, hazard ratio 0.5, 95% CI 0.3-0.9) after adjustment for PS and confounders: age, male sex, cognitive deterioration, uncured malignancies, left ventricular ejection fraction ≤45%, estimated glomerular filtration rate ≤35 mL/min, ST-segment elevation myocardial infarction, mitral regurgitation, and medication at discharge with clopidogrel and statins.

Conclusion: In octogenarians with ACS, PCI was associated with improved survival from all-cause death over 5 years of follow-up.

No MeSH data available.


Related in: MedlinePlus

Kaplan–Meier survival curves for all-cause mortality of PCI-treated patients versus non-PCI-treated patients in propensity-matched cohort.Abbreviation: PCI, percutaneous coronary intervention.
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f2-cia-10-1547: Kaplan–Meier survival curves for all-cause mortality of PCI-treated patients versus non-PCI-treated patients in propensity-matched cohort.Abbreviation: PCI, percutaneous coronary intervention.

Mentions: In the overall cohort (n=353), all-cause mortality was 46.2% (84 events) and 89.5% (153 events) in those treated with PCI and those not treated with PCI, respectively. After PS matching (n=142), all-cause mortality was 54.9% (39 events) and 83.1% (59 events) in the PCI and non-PCI subgroups, respectively. Kaplan–Meier survival curves and log rank test (P=0.001) showed significantly improved survival in patients treated with PCI compared with patients not treated with PCI. The 5-year mean survival time after PCI was 48 months (95% CI 41–54), whereas 5-year mean survival time without PCI was 35 months (95% CI 29–42) (Figure 2).


Acute coronary syndrome in octogenarians: association between percutaneous coronary intervention and long-term mortality.

Barywani SB, Li S, Lindh M, Ekelund J, Petzold M, Albertsson P, Lund LH, Fu ML - Clin Interv Aging (2015)

Kaplan–Meier survival curves for all-cause mortality of PCI-treated patients versus non-PCI-treated patients in propensity-matched cohort.Abbreviation: PCI, percutaneous coronary intervention.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4592028&req=5

f2-cia-10-1547: Kaplan–Meier survival curves for all-cause mortality of PCI-treated patients versus non-PCI-treated patients in propensity-matched cohort.Abbreviation: PCI, percutaneous coronary intervention.
Mentions: In the overall cohort (n=353), all-cause mortality was 46.2% (84 events) and 89.5% (153 events) in those treated with PCI and those not treated with PCI, respectively. After PS matching (n=142), all-cause mortality was 54.9% (39 events) and 83.1% (59 events) in the PCI and non-PCI subgroups, respectively. Kaplan–Meier survival curves and log rank test (P=0.001) showed significantly improved survival in patients treated with PCI compared with patients not treated with PCI. The 5-year mean survival time after PCI was 48 months (95% CI 41–54), whereas 5-year mean survival time without PCI was 35 months (95% CI 29–42) (Figure 2).

Bottom Line: Cox regression analysis in overall cohort by adjustment for ten baseline variables showed statistically significant association between PCI and reduced long-term mortality (P<0.001, hazard ratio 0.4, 95% confidence interval [CI] 0.2-0.5).Furthermore, by performing Cox regression analysis, PCI was still associated with reduced long-term mortality (P=0.029, hazard ratio 0.5, 95% CI 0.3-0.9) after adjustment for PS and confounders: age, male sex, cognitive deterioration, uncured malignancies, left ventricular ejection fraction ≤45%, estimated glomerular filtration rate ≤35 mL/min, ST-segment elevation myocardial infarction, mitral regurgitation, and medication at discharge with clopidogrel and statins.In octogenarians with ACS, PCI was associated with improved survival from all-cause death over 5 years of follow-up.

View Article: PubMed Central - PubMed

Affiliation: Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Sahlgrenska University Hospital/Östra Hospital, Gothenburg, Sweden.

ABSTRACT

Aim: Evidence of improved survival after use of percutaneous coronary intervention (PCI) in elderly patients with acute coronary syndrome (ACS) is limited. We assessed the association between PCI and long-term mortality in octogenarians with ACS.

Methods and results: We followed 353 consecutive patients aged ≥80 years hospitalized with ACS during 2006-2007. Among them, 182 were treated with PCI, whereas 171 were not. PCI-treated patients were younger and more often male, and had less stroke and dependency in activities of daily living, but there were no significant differences in occurrence of diabetes mellitus, chronic obstructive pulmonary disease, hypertension, and uncured malignancies between the two groups. The association between PCI and all-cause mortality was assessed in the overall cohort and a 1:1 matched cohort based on propensity score (PS). In overall cohort, 5-year all-cause mortality was 46.2% and 89.5% in the PCI and non-PCI groups, respectively. Cox regression analysis in overall cohort by adjustment for ten baseline variables showed statistically significant association between PCI and reduced long-term mortality (P<0.001, hazard ratio 0.4, 95% confidence interval [CI] 0.2-0.5). In propensity-matched cohort, 5-year all-cause mortality was 54.9% and 83.1% in the PCI and non-PCI groups, respectively. Kaplan-Meier survival curves and log rank test showed significantly improved mean survival rates (P=0.001): 48 months (95% CI 41-54) for PCI-treated patients versus 35 months (95% CI 29-42) for non-PCI-treated patients. Furthermore, by performing Cox regression analysis, PCI was still associated with reduced long-term mortality (P=0.029, hazard ratio 0.5, 95% CI 0.3-0.9) after adjustment for PS and confounders: age, male sex, cognitive deterioration, uncured malignancies, left ventricular ejection fraction ≤45%, estimated glomerular filtration rate ≤35 mL/min, ST-segment elevation myocardial infarction, mitral regurgitation, and medication at discharge with clopidogrel and statins.

Conclusion: In octogenarians with ACS, PCI was associated with improved survival from all-cause death over 5 years of follow-up.

No MeSH data available.


Related in: MedlinePlus