Introduction The elderly account for an increasing proportion of the population and have a high prevalence of coronary heart disease. Percutaneous coronary intervention (PCI) is the most common method of revascularisation in the elderly. This study examines whether case-mix and peri-procedural outcome are different in the elderly (≥75 years), and explores the impact of increasing age on PCI case-mix and outcomes over time.
Methods The Scottish Coronary Revascularisation Register was used to undertake a retrospective cohort study on all 40 933 patients undergoing non-emergency PCI in Scotland between April 1998 and March 2008 inclusive. The Register collects comprehensive, prospective information on all patients undergoing PCI in Scotland, including demographic characteristics, postcode of residence, cardiac disease severity, co-morbidity, procedure details, past medical and surgical history, and in-hospital complications. Datalinkage with the Scottish Morbidity Record 01 and the Registrar General for Scotland provided follow up data.
Results There was an increase in the number and percentage of PCIs undertaken in elderly patients, from 111 (2.5%) in 1998 to 848 (11.1%) in 2008. Compared with younger patients, the elderly were more likely to have multi-vessel disease, multiple comorbidity and a past history of myocardial infarction or coronary artery bypass grafting (χ2 tests, all p<0.001). The elderly had a higher risk of major adverse cardiovascular events within 30 days of PCI (4.5% vs 2.8%, χ test p<0.001). Over the 10-year-period, there was a significant increase in the proportion of elderly patients who had multiple comorbidity (χ test for trend, p<0.001). In spite of this, the risk of adverse outcomes did not change significantly over time in the elderly, and fell overall.
Conclusions Our findings suggest that the increasing age and comorbidity of patients undergoing PCI have been offset by technological and therapeutic improvements in negating the adverse impact of age on peri-procedural adverse events.
- time trends
- percutaneous coronary intervention