Bleeding outcomes after non-emergency percutaneous coronary intervention in the very elderly

Background Octogenarians constitute an increasing proportion of patients presenting for non-emergency percutaneous coronary intervention （PCI）. Methods This study evaluated the in-hospital procedural characteristics and outcomes, including the bleeding events of 293 octogenarians presenting between January 2010 and December 2012 for non-emergency PCI to a single large volume tertiary care Aus- tralian center. Comparisons were made with 293 consecutive patients aged less than or equal to 60 years, whose lesions were matched with the octogenarians. Results Non-ST elevation myocardial infarction was the most frequent indication for non-emergency PCI in octoge- narians. Compared to the younger cohort, they had a higher prevalence of co-morbidities and more complex coronary disease, comprising more type C and calcified lesions. Peri-procedural use of low molecular weight heparin （LMWH; 1.0% vs. 5.8%; P 〈 0.001） and glycopro- tein IIb/IIIa inhibitors （2.1% vs. 9.6%; P 〈 0.001） was lower, while femoral arterial access was used more commonly than in younger patients （80.9% vs. 67.6%; P 〈 0.001）. Overall, there was a non-significant trend towards higher incidence of all bleeding events in the elderly （9.2% vs. 5.8%; P = 0.12）. There was no significant difference in access site or non-access site bleeding and major or minor bleeding between the two cohorts. Sub-analysis did not reveal any significant influence on bleeding rates by the use of LMWH, glycoprotein IIb/IIIa inhibitors or femoral arterial access. In addition, there were no significant differences in the rates of in-hospital mortality, stroke or acute stent thrombosis between the two groups. Conclusions In this single center study, we did not observe significant increases in adverse in-hospital outcomes including the incidence of bleeding in octogenarians undergoing non-emergency PCI.

The utility of coronary computed tomography angiography in elderly patients

Background Coronary computed tomography angiography(CCTA)is often avoided in elderly patients due to a presumption that a high proportion of patients will have heavily calcified plaque limiting an accurate assessment.We sought to assess the image quality,luminal stenosis and utility of CCTA in elderly patients with suspected coronary artery disease(CAD)and stable chest pain.Methods Retrospective analysis of elderly patients(>75 years)who underwent 320-detector row CCTA between 2012–2017 at MonashHeart.The CCTA was analysed for degree maximal coronary stenosis by CAD-RADS classification,image quality by a 5-point Likert score(1-poor,2-adequate,3-good,4-very good,5-excellent)and presence of artefact limiting interpretability.Results 1011 elderly patients(62%females,78.8±3.3 years)were studied.Cardiovascular risk factor prevalence included:hypertension(65%),hyperlipidaemia(48%),diabetes(19%)and smoking(21%).The CCTA was evaluable in 68%of patients which included 52%with non-obstructive CAD(<50%stenosis),48%with obstructive CAD(>50%)stenosis.Mean Likert score was 3.1±0.6 corresponding to good image quality.Of the 323(32%)of patients with a non-interpretable CCTA,80%were due to calcified plaque and 20%due to motion artefact.Male gender(P=0.009),age(P=0.02),excess motion(P<0.01)and diabetes mellitus(P=0.03)were associated with non-interpretable CCTA.Conclusion Although CCTA is a feasible non-invasive tool for assessment of elderly patients with stable chest pain,clinicians should still be cautious about referring elderly patients for CCTA.Patients who are male,diabetic and>78 years of age are significantly less likely to have interpretable scans.