CTO-PCI bij octogenaren: vergelijkbare acute en 1-jaarsresultaten, maar hoger langdurig sterftecijfer
Een retrospectieve single-center studie vergeleek de uitkomsten van succesvolle CTO-PCI bij 123 patiënten ≥80 jaar met 612 jongere patiënten. Hoewel octogenaren vaker chronische nierziekte en atriumfibrilleren hadden en vaker een contrastnefropatie ontwikkelden, waren de acute complicaties en 1-jaars target lesion failure (TLF) vergelijkbaar (16,2% vs 12,3%; p=0,191). Op lange termijn was het cardiale sterftecijfer wel significant hoger (7,6% vs 2,7%; HR 2,82). Dit bevestigt dat CTO-PCI veilig kan worden toegepast bij zeer oude patiënten, maar benadrukt dat de onderliggende comorbiditeit en natuurlijke sterftecijfer de langetermijnprognose blijven bepalen.
Abstract (original)
INTRODUCTION: Older patients often present with complex coronary artery disease alongside multiple comorbidities. There is limited data on the outcomes of percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) in octogenarians. We aim to investigate the in-hospital and 1-year outcomes following successful CTO-PCI in octogenarians. METHODS: Consecutive patients who had successful CTO-PCI at a single center between 01.2017 and 12.2022 were divided into two groups: octogenarians (age ≥ 80 and < 90 years, n = 123) and a control group (age < 80 years, n = 612). Periprocedural complications, in-hospital major adverse cardiac and cerebrovascular events (MACCE), and 1-year target lesion failure (TLF) were investigated. RESULTS: Octogenarians had a higher prevalence of arterial hypertension (96.7% vs. 91.2%, p = 0.036), atrial fibrillation (28.5% vs. 12.1%, p < 0.001), and chronic kidney disease (CKD) (34.1% vs. 16.5%, p < 0.001) compared to younger counterparts. The rate of failed CTO recanalization was higher in octogenarians (18.5% vs. 8.2%, p < 0.001). Incidence of in-hospital MACCE and periprocedural complications was comparable between the study groups, except for a numerically higher in-hospital mortality in octogenarians (2.4% vs. 0.8%, p = 0.114), and a higher incidence of contrast-induced nephropathy (CIN) (11.4% vs. 4.9%, p = 0.006). At 1 year, TLF did not differ significantly between the study arms (16.2% vs. 12.3%, aHR 1.52; CI 0.81-2.84, p = 0.191). Notably, higher cardiac mortality rates were observed in the octogenarian arm (7.6% vs. 2.7%, HR 2.82; CI 1.13-7.08, p = 0.027). CONCLUSION: Despite numerically higher in-hospital mortality in octogenarians, CTO-PCI in those patients was performed with comparable periprocedural, and acute adverse outcomes, as well as 1-year TLF, to their younger counterparts. Octogenarians remain inherently at a higher long-term mortality risk. Graphical Abstract available for this article. GOV IDENTIFIER: NCT06957613 (retrospectively registered, 03/05/2025).
Dit artikel is een samenvatting van een publicatie in Cardiology and therapy. Voor het volledige artikel, alle details en referenties verwijzen wij u naar de oorspronkelijke bron.
Lees het volledige artikelDOI: 10.1007/s40119-026-00485-1
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