0
PCI IN ELDERLY        - DEV PAHLAJANI         MD,FACC,FSCAI         CHIEF OF CARDIOLOGY,         BREACH CANDY HOSPITAL,MUM...
ELDERLY POPULATION:        A GROWING GLOBAL CHALLENGE• IN USA, 35 MILL…………….IN 2000• 82 MILL…………………………. IN 2030    ABOVE 8...
GRACE: FOR HIGH RISK ACS                    AGE 18466 patients dynamic ECG changes +ve cardiac markers 44% > 70 yrs. ...
DEFINITION OF ELDERLY NO UNIVERSALLY ACCEPTED DEFINITION            WHO: 60 YRS. MOST US CLASSIFICATION 65 AND ABOVE   ...
Management and 6-month Outcomes in   Elderly and Very Elderly Patients withHigh-Risk non-ST-elevation Acute Coronary      ...
Inhospital events for high-risk patients with                      NSTE-ACS                                            <70...
Inhospital events for high-risk patients with                       NSTE-ACS                                            70...
Inhospital events for high-risk patients with                      NSTE-ACS                                            >80...
Reperfusion Therapy In Elderly Patients With Acute             Myocardial Infarction : A Randomized Comparison Of Primary ...
Clinical Course of the Two Patient Groups                         Angioplasty             Streptokinase                   ...
100                         90  Overall Survival (%)                            PCI                         80        P = ...
100                                    90    Survival free of reinfarction                         PCI           or stroke...
Six-month outcomes for high-risk patients with                   NSTE-ACS                                             <70 ...
Six-month outcomes for high-risk patients with                   NSTE-ACS                                             70–8...
Six-month outcomes for high-risk patients with                   NSTE-ACS                                             >80 ...
Six-month post-discharge outcomes in young, accordingto those who did and did not undergo revascularization.              ...
Six-month post-discharge outcomes in elderly age                 groups according to those who did and did not            ...
Six-month post-discharge outcomes in very elderly               age groups according to those who did and did not         ...
Optimal Medical Therapy With or Without      Percutaneous Coronary Intervention in    Older Patients With Stable Coronary ...
COURAGE TRIAL                  Primary and Secondary Outcomes by                     Treatment Arm and Age Group          ...
COURAGE TRIAL                  Primary and Secondary Outcomes by                     Treatment Arm and Age Group          ...
Survival of Elderly Patients Undergoing                     Percutaneous             Coronary Intervention for     Acute M...
Clinical Outcomes :         In-Hospital                             Age ≥ 75 Years      Age <75 Years           p ValueIn-...
Clinical Outcomes : 30 Days                           Age ≥ 75 Years   Age <75 Years      p Value30 days (n = 141)Mortalit...
Clinical Outcomes : One year                           Age ≥ 75 Years   Age <75 Years        p Value1 year (n = 117) Morta...
PCI IN AMI SHOCKKaplan-Meier Estimates of Cumulative 1-Year Survival                                                      ...
PCI IN AMI SHOCKKaplan-Meier Estimates of Cumulative 1-Year Freedom From MACE                                             ...
PCI IN AMI SHOCK                 Multivariate Analysis of In-Hospital Mortality           Variable              Odds Ratio...
Long-Term Paclitaxel-Eluting Stent      Outcomes in Elderly Patients Daniel E. Forman, MD; David A. Cox, MD; Stephen G. El...
5-year cumulative rates of death (upper left), MI(upper right), Academic Research Consortium, definite/probable ST (lower ...
5-year cumulative rates of death (upper left), MI (upper right), Academic ResearchConsortium, definite/probable ST (lower ...
TAKE HOME MESSAGE PCI results in elderly are comparable with younger population  due to improved tech. Hardware and des ...
Thank you!!
Upcoming SlideShare
Loading in...5
×

PCI in elderly patients

1,453

Published on

Published in: Health & Medicine, Technology
0 Comments
2 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
1,453
On Slideshare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
67
Comments
0
Likes
2
Embeds 0
No embeds

No notes for slide

Transcript of "PCI in elderly patients"

  1. 1. PCI IN ELDERLY - DEV PAHLAJANI MD,FACC,FSCAI CHIEF OF CARDIOLOGY, BREACH CANDY HOSPITAL,MUMBAI
  2. 2. ELDERLY POPULATION: A GROWING GLOBAL CHALLENGE• IN USA, 35 MILL…………….IN 2000• 82 MILL…………………………. IN 2030 ABOVE 80 YRS. 9.3 MILLION TO DOUBLE BY 2030
  3. 3. GRACE: FOR HIGH RISK ACS AGE 18466 patients dynamic ECG changes +ve cardiac markers 44% > 70 yrs. < 70 yrs.-10380 70-80 - 5057 80 + - 3029
  4. 4. DEFINITION OF ELDERLY NO UNIVERSALLY ACCEPTED DEFINITION  WHO: 60 YRS. MOST US CLASSIFICATION 65 AND ABOVE  GRACE ACS 70YRS.
  5. 5. Management and 6-month Outcomes in Elderly and Very Elderly Patients withHigh-Risk non-ST-elevation Acute Coronary Syndromes: The Global Registry of Acute Coronary Events Gerard Devlin, Joel M. Gore, John Elliott, Namal Wijesinghe, Kim A. Eagle, Álvaro Avezum, Wei Huang and David Brieger for the GRACE Investigators
  6. 6. Inhospital events for high-risk patients with NSTE-ACS <70 years (n = 10 380) With PCI/CABG Without PCI/CABG 45% (n = 4612) 55% (n = 5694)CHF/pulmonary oedema, n (%) 316 (6.9) 488 (8.6), P < 0.01Recurrent ischaemia, n (%) 1169 (26) 1311 (23), P < 0.01Major bleeding, n (%) 102 (2.2) 73 (1.3), P < 0.001Stroke, n (%) 21 (0.4) 20 (0.4), P = 0.6Death, n (%) 87 (1.6) 203 (2.9), P < 0.001 Eur. HJ 2008, 29, 1275
  7. 7. Inhospital events for high-risk patients with NSTE-ACS 70–80 years (n = 5057) With PCI/CABG Without PCI/CABG 35% (n = 1741) 65% (n = 3291)CHF/pulmonary oedema, n (%) 243 (14) 623 (19), P < 0.0001Recurrent ischaemia, n (%) 533 (31) 775 (24), P < 0.0001Major bleeding, n (%) 57 (3.3) 89 (2.7), P = 0.25Stroke, n (%) 22 (0.7) 16 (0.9), P = 0.3Death, n (%) 95 (4.3) 262 (6.2), P < 0.001 Eur. HJ 2008, 29, 1275
  8. 8. Inhospital events for high-risk patients with NSTE-ACS >80 years (n = 3029) With PCI/CABG Without PCI/CABG 21% (n = 620) 79% (n = 2390)CHF/pulmonary oedema, n (%) 124 (20) 539 (23), P = 0.2Recurrent ischaemia, n (%) 182 (29) 511 (22), P < 0.0001Major bleeding, n (%) 43 (7.0) 80 (3.4), P < 0.0001Stroke, n (%) 3 (0.9) 21 (0.5), P = 0.45Death, n (%) 57 (7.0) 363 (11), P < 0.001 Eur. HJ 2008, 29, 1275
  9. 9. Reperfusion Therapy In Elderly Patients With Acute Myocardial Infarction : A Randomized Comparison Of Primary Angioplasty And Thrombolytic Therapy Menko-Jan de Boer, MD*, Jan-Paul Ottervanger, MD*, Arnoud W.J van’t Hof, MD*, Jan C.A Hoorntje, MD*, Harry Suryapranata, MD*, Felix Zijlstra, MD*, the Zwolle Myocardial Infarction Study Group Zwolle, the Netherlands
  10. 10. Clinical Course of the Two Patient Groups Angioplasty Streptokinase (n 46) p Value (n 41)Mortality in-hospital,n (%) 3 (7) 0.07 8 (20)Stroke, n (%) 1 (2) 0.34 3 (7)Recurrent AMI, n (%) 1 (2) 0.01 6 (15)Bleeding (noncerebral) 5 (11) 0.72 3 (7) JACC 2002, 39, 1723
  11. 11. 100 90 Overall Survival (%) PCI 80 P = 0.04 70 STK 0 1 2 yearOverall survival for patients randomized for angioplasty treatment (solid line)and thrombolysis Treatment (dotted line) during 24 6 months of follow-up(p = 0.04, relative risk: 2.5, 95% confidence interval: 1.0 to 6.2). JACC 2002, 39, 1723
  12. 12. 100 90 Survival free of reinfarction PCI or stroke (%) 80 70 P = 0.003 60 STK 50 0 1 2 yearOverall survival free of recurrent infarction or stroke for patients randomized forangioplasty treatment (dashed line) and thrombolysis treatment (doted line)during 24 6 months of follow-up (p = 0.003, relative risk: 3.1, 95% confidenceinterval: 1.4 to 7.0). JACC 2002, 39, 1723
  13. 13. Six-month outcomes for high-risk patients with NSTE-ACS <70 years (n = 10 380) With PCI/CABG Without PCI/CABG 45% (n = 4612) 55% (n = 5694)Death, n (%) 74 (1.7) 191 (3.5), P < 0.0001Myocardial infarction, n (%) 85 (2.2) 128 (2.9), P = 0.06Stroke, n (%) 18 (0.4) 46 (0.9), P < 0.01Triple endpoint, n (%) 170 (3.8) 337 (6.2), P < 0.0001Re-admission for cardiac 695 (17) 842 (16), P = 0.7event, n (%) Eur. HJ 2008, 29, 1275
  14. 14. Six-month outcomes for high-risk patients with NSTE-ACS 70–80 years (n = 5057) With PCI/CABG Without PCI/CABG 35% (n = 1741) 65% (n = 3291)Death, n (%) 50 (3.0) 268 (8.5), P < 0.0001Myocardial infarction, n (%) 51 (3.5) 141 (5.4), P < 0.01Stroke, n (%) 27 (1.7) 39 (1.3), P = 0.30Triple endpoint, n (%) 118 (7.0) 415 (13), P < 0.0001Re-admission for cardiac 275 (17) 647 (22), P < 0.01event, n (%) Eur. HJ 2008, 29, 1275
  15. 15. Six-month outcomes for high-risk patients with NSTE-ACS >80 years (n = 3029) With PCI/CABG Without PCI/CABG 21% (n = 620) 79% (n = 2390)Death, n (%) 69 (12) 420 (19), P < 0.0001Myocardial infarction, n (%) 27 (5.2) 146 (8.1), P = 0.03Stroke, n (%) 12 (2.2) 62 (3.1), P = 0.24Triple endpoint, n (%) 98 (17) 564 (25), P < 0.0001Re-admission for cardiac 128 (23) 531 (26), P = 0.1event, n (%) Eur. HJ 2008, 29, 1275
  16. 16. Six-month post-discharge outcomes in young, accordingto those who did and did not undergo revascularization. 40 30 P<0.0001 Patients (%) 20 P<0.01 17 15 P<0.0001 10 3.8 6.2 1.7 3.5 2.2 2.9 0.4 0.9 0 Death MI Stroke Triple endpoint Re-admission for cardiac Revasc + Revasc - illness Eur. HJ 2008, 29, 1275
  17. 17. Six-month post-discharge outcomes in elderly age groups according to those who did and did not undergo revascularization. 40 P<0.0001 30Patients (%) 22 20 P<0.0001 P<0.01 17 13 10 8.5 7 3 3.5 5.4 1.7 1.3 0 Death MI Stroke Triple Re-admission endpoint for cardiac illness Revasc + Revasc - Eur. HJ 2008, 29, 1275
  18. 18. Six-month post-discharge outcomes in very elderly age groups according to those who did and did not undergo revascularization. P<0.0001 40 P=0.03 P<0.0001 30 25 26Patients (%) 23 19 17 20 12 10 8.1 5.2 2.2 3.1 0 Death MI Stroke Triple endpoint Re-admission for cardiac illness Revasc + Revasc - Eur. HJ 2008, 29, 1275
  19. 19. Optimal Medical Therapy With or Without Percutaneous Coronary Intervention in Older Patients With Stable Coronary Disease A Pre-Specified Subset Analysis of the COURAGE(Clinical Outcomes Utilizing Revascularization and Aggressive drug Evaluation) Trial • Koon K. Teo, MB, BCh, PhD*, Steven P. Sedlis, MD, William E. Boden, MD,*, Robert A. ORourke, MD, David J. Maron, MD||, Pamela M.Hartigan, PhD¶, Marcin• Dada, MD#, Vipul Gupta, MBBS, MPH, John A. Spertus, MD, MPH**, William J.Kostuk, MD, Daniel S. Berman, MD, Leslee J. Shaw, PhD, Bernard R.Chaitman, MD||||, G.B. John Mancini, MD¶¶, William S. Weintraub, MD## COURAGE Trial Investigators JACC 2009, 54, 1303
  20. 20. COURAGE TRIAL Primary and Secondary Outcomes by Treatment Arm and Age Group Age <65 Yrs (n = 1,381) OMT PCI HR p ValueOutcome (n = 693) (n = 688) (95% CI)Death 41 (6%) 25 (4%) 0.68 (0.42–1.10) 0.11MI 76 (11%) 83 (12%) 1.12 (0.82–1.53) 0.44Death/MI 110 (16%) 109 (16%) 1.01 (0.78–1.31) 0.93Death/MI/stroke 115 (17%) 115 (17%) 1.02 (0.79–1.33) 0.86ACS 85 (12%) 87 (13%) 1.03 (0.77–1.39) 0.83 JACC 2009, 54, 1303
  21. 21. COURAGE TRIAL Primary and Secondary Outcomes by Treatment Arm and Age Group Age >65 Yrs (n = 904) OMT PCI HR Interaction Outcome (n = 444) (n = 460) (95% CI) p Value p ValueDeath 54 (12%) 57 (12%) 1.01 (0.69–1.46) 0.97 0.21MI 52 (12%) 60 (13%) 1.14 (0.79–1.66) 0.48 0.95Death/MI 93 (21%) 104 (23%) 1.10 (0.83–1.45) 0.51 0.66Death/MI/stroke 99 (22%) 109 (24%) 1.08 (0.82–1.42) 0.58 0.77ACS 40 (9%) 49 (11%) 1.19 (0.79–1.81) 0.41 0.58 JACC 2009, 54, 1303
  22. 22. Survival of Elderly Patients Undergoing Percutaneous Coronary Intervention for Acute Myocardial Infarction Complicated by Cardiogenic Shock Han S. Lim, MBBS*,**, Omar Farouque, MBBS, FRACP, PhD, FACC*,, Nick Andrianopoulos, MBBS, MBiostat, Bryan P. Yan, MBBS, FRACP,, Chris C.S. Lim,MBBS||, Angela L. Brennan, RN, CCRN, Chris M. Reid, BA, MSc, DipEd, PhD, Melanie Freeman, MBBS*, Kerrie Charter, RN, CCRN*, Alexander Black, MBBS, FRACP,,¶, Gishel New, MBBS, FRACP, PhD, FACC||, Andrew E. Ajani, MBBS, FRACP, FJFICM,MD,,, Stephen J. Duffy, MBBS, MRCP, FRACP, PhD#, David J. Clark, MBBS, FRACP*,* on behalf of the Melbourne Interventional Group JACC Intv. 2009, 2, 146
  23. 23. Clinical Outcomes : In-Hospital Age ≥ 75 Years Age <75 Years p ValueIn-hospital (n = 143)Mortality 19 (42.2) 33 (33.7 0.33 Complications Periprocedural MI 2 (4.7) 2 (2.1) 0.41 Emergency PCI 1 (2.3) 1 (1.0) 0.53 Unplanned CABG 1 (2.3) 4 (4.3) 1.00 Bleeding 4 (8.9) 3 (3.1) 0.21 Congestive heart failure 18 (40.0) 25 (25.5) 0.08 Renal failure 13 (28.9) 12 (12.2) 0.02 Stroke 1 (2.2) 2 (2.0) 1.00 JACC Intv. 2009, 2, 146
  24. 24. Clinical Outcomes : 30 Days Age ≥ 75 Years Age <75 Years p Value30 days (n = 141)Mortality 19 (43.2) 35 (36.1) 0.42MI 2 (4.5) 3 (3.1) 0.65TVR 2 (4.5) 6 (6.2) 0.70MACE 22 (50.0) 40 (41.2) 0.33 JACC Intv. 2009, 2, 146
  25. 25. Clinical Outcomes : One year Age ≥ 75 Years Age <75 Years p Value1 year (n = 117) Mortality 20 (52.6) 37 (46.8) 0.56 Cardiac 17 (85.0) 34 (91.9) 0.65 Noncardiac 3 (15.0) 3 (8.1) 0.65 MI 2 (5.3) 3 (3.8) 0.66 TLR 3 (7.9) 5 (6.3) 0.71 TVR 3 (7.9) 6 (7.6) 0.96 MACE 24 (63.2) 42 (53.2) 0.31 JACC Intv. 2009, 2, 146
  26. 26. PCI IN AMI SHOCKKaplan-Meier Estimates of Cumulative 1-Year Survival JACC Intv. 2009, 2, 146
  27. 27. PCI IN AMI SHOCKKaplan-Meier Estimates of Cumulative 1-Year Freedom From MACE JACC Intv. 2009, 2, 146
  28. 28. PCI IN AMI SHOCK Multivariate Analysis of In-Hospital Mortality Variable Odds Ratio 95% CI p ValueRenal failure 3.41 1.21–9.63 0.02IABP use 2.11 0.97–4.59 0.06STEMI 0.55 0.22–1.38 0.20Diabetes 1.63 0.70–3.76 0.26Hypertension 1.59 0.69–3.63 0.27Age ≥ 75 years 1.04 0.46–2.36 0.93 JACC Intv. 2009, 2, 146
  29. 29. Long-Term Paclitaxel-Eluting Stent Outcomes in Elderly Patients Daniel E. Forman, MD; David A. Cox, MD; Stephen G. Ellis, MD;John M. Lasala, MD; John A. Ormiston, MD; Gregg W. Stone, MD; Mark A. Turco, MD; Jeanne Y. Wei, MD; Anita A. Joshi, MD; Keith D. Dawkins, MD and Donald S. Baim, MD Circ Card. Vasc. Intv. 2009 2, 178
  30. 30. 5-year cumulative rates of death (upper left), MI(upper right), Academic Research Consortium, definite/probable ST (lower left), and TLR (lower right) for patients receiving PES in the randomized trials Circ. Card. Vasc. Intv. 2009 2, 178
  31. 31. 5-year cumulative rates of death (upper left), MI (upper right), Academic ResearchConsortium, definite/probable ST (lower left), and target lesion revascularization (TLR) (lower right) for PES versus BMS in patients aged >70 years in the randomized trials Circ. Card. Vasc. Intv. 2009 2, 178
  32. 32. TAKE HOME MESSAGE PCI results in elderly are comparable with younger population due to improved tech. Hardware and des The results of PCI including multi site arterial involvement have become acceptable Number of elderly is growing due to improved longevity
  33. 33. Thank you!!
  1. A particular slide catching your eye?

    Clipping is a handy way to collect important slides you want to go back to later.

×