Adverse events are common in patients 65 and older who undergo percutaneous coronary intervention (PCI), or angioplasty, to treat the narrowed unprotected left main coronary artery, according to AHRQ’s Effective Health Care Program. PCI is used to treat less than 5 percent of patients with unprotected left main coronary artery stenosis and is generally reserved for patients at high surgical risk. Negative effects in elderly patients are common and are likely influenced by both patient and procedural factors, including the type of stent used. The study, “Characteristics and Long-Term Outcomes of Percutaneous Revascularization of Unprotected Left Main Coronary Artery Stenosis in the United States,” published in the Journal of the American College of Cardiology, showed 40 percent of elderly patients die within the first three years of follow-up after the procedure. Select to access the abstract on PubMed.®
Characteristics and long-term outcomes of ... [J Am Coll Cardiol. 2012] - PubMed - NCBI
J Am Coll Cardiol. 2012 Feb 14;59(7):648-54.
Characteristics and long-term outcomes of percutaneous revascularization of unprotected left main coronary artery stenosis in the United States: a report from the National Cardiovascular Data Registry, 2004 to 2008.
Brennan JM, Dai D, Patel MR, Rao SV, Armstrong EJ, Messenger JC, Curtis JP, Shunk KA, Anstrom KJ, Eisenstein EL, Weintraub WS, Peterson ED, Douglas PS, Hillegass WB.
SourceDepartment of Medicine, Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina 27705, USA. firstname.lastname@example.org
OBJECTIVES:This study sought to assess percutaneous coronary intervention (PCI) for unprotected left main coronary artery (ULMCA) stenosis in routine U.S. clinical practice.
BACKGROUND:Percutaneous coronary intervention for ULMCA stenosis is controversial; however, current use and outcomes of ULMCA PCI in routine U.S. clinical practice have not been described.
METHODS:We evaluated 5,627 patients undergoing ULMCA PCI at 693 centers within the National Cardiovascular Data Registry Catheterization Percutaneous Coronary Intervention Registry for temporal trends in PCI use (2004 to 2008), patient characteristics, and in-hospital mortality. Thirty-month mortality and composite major adverse events (death, myocardial infarction, and revascularization) with drug-eluting versus bare-metal stents were compared using inverse probability weighted (IPW) hazard ratios (HRs) in a nonrandomized Medicare-linked (age ≥65 years) patient cohort (n = 2,765).
RESULTS:ULMCA PCI was performed in 4.3% of patients with ULMCA stenosis. Unadjusted in-hospital mortality rates ranged from 2.9% for elective cases to 45.1% for emergent/salvage cases. By 30 months, 57.9% of the elderly ULMCA PCI population experienced death, myocardial infarction, or revascularization, and 42.7% died. Patients receiving drug-eluting stents (versus bare-metal stents) had a lower 30-month mortality (IPW HR: 0.84, 95% confidence interval [CI]: 0.73 to 0.96), but the composite of major adverse events were similar (IPW HR: 0.95, 95% CI: 0.84 to 1.06).
CONCLUSIONS:In the United States, ULMCA PCI is performed in <5% of patients with ULMCA disease and is generally reserved for those at high procedural risk. Adverse events are common in elderly patients and are related to patient and procedural characteristics, including stent type.
Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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