Mortality Increasing in Elderly PCI Patients

Elderly patients undergoing PCI are increasingly characterized by a higher comorbidity burden and are more likely to present with acute MI, according to results of a large U.S. registry study presented at TCT 2015. In-hospital and 30-day mortality rates are also on the rise, with the largest increase seen in patients undergoing elective PCI.

Christina Vassileva, MD, of Southern Illinois University School of Medicine, Springfield, Illinois, and colleagues analyzed records of 3,387,976 Medicare beneficiaries aged at least 65 years who underwent PCI between January 2000 and November 2012. The number of PCIs per year increased from 246,528 in 2000 to 318,622 in 2006, and then fell to 161,667 by the end of 2012.

Overall comorbidity among patients increased over time—with rises in the prevalence of hypertension, diabetes, renal failure, and acute MI—as did rates of in-hospital and 30-day mortality. Additionally, the proportion of procedures that were elective rose during the study period.

In-hospital mortality was 1% for elective, 2.1% for urgent and 4.5% for emergent admissions. The most substantial increase for in-hospital mortality was observed in patients who underwent elective procedures (0.8% in 2000 vs 3.4% in 2012). Additionally, patients treated in 2012 compared with 2000 were more likely to die in the hospital (OR 1.42; 95% CI 1.36-1.48).

Median patient age (75 years) did not change over the course of the study, but the proportion of those who were female dropped from 43.5% in 2000 to 40.4% in 2012. Bare-metal stent usage fell from 85.7% in 2000 to 23.5% in 2012 with a corresponding increase in the use of drug-eluting stents, which peaked in 2005 at 84.1% and settled at 70.3% in 2012. About one in 10 patients underwent angioplasty, and 90.4% underwent PCI with stent placement.

Overall survival was 93% at 6 months, 90% at 1 year, 80% at 3 years and 69% at 5 years. The 5-year survival rate held steady at 70% from 2000 through 2006 and then declined slightly to 66% through 2009.

Vassileva told TCT Daily that the mortality rise seen even after adjustment for morbidity burden “may in part be related to the fact that outpatient PCI is being more commonly performed, and some of the patients with more straightforward CAD or fewer comorbidities are being shifted into the outpatient setting.” The study did not capture PCIs performed without a hospital admission, she said.

“Patients presenting for PCI are now sicker than they were in the past,” Vassileva continued. “Accordingly, we need to pay more attention to the multitude of comorbidities these patients have to optimize their outcomes.”