Percutaneous coronary intervention of unprotected left main and bifurcation in octogenarians: Subanalysis from RAIN (veRy thin stents for patients with left mAIn or bifurcatioN in real life)
Objective Outcomes of complex percutaneous coronary interventions (PCIs) in older patients are still debated. The aim of the study was to evaluate clinical outcomes of Octogenarian patients treated with ultrathinstents on left main or on coronary bifurcations, compared with younger patients. Methods...
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| Veröffentlicht in: | Catheterization and cardiovascular interventions 2021-04, Vol.97 (5), p.755-763 |
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| creator | Conrotto, Federico D'Ascenzo, Fabrizio Piroli, Francesco Franzé, Alfonso Luca, Leonardo Quadri, Giorgio Ryan, Nicola Escaned, Javier Bo, Mario De Ferrari, Gaetano Maria |
| description | Objective
Outcomes of complex percutaneous coronary interventions (PCIs) in older patients are still debated.
The aim of the study was to evaluate clinical outcomes of Octogenarian patients treated with ultrathinstents on left main or on coronary bifurcations, compared with younger patients.
Methods
All consecutive patients presenting a critical lesion of an unprotected left main (ULM) or a bifurcation and treated with very thin stents were included in the RAIN (veRy thin stents for patients with left mAIn or bifurcatioN in real life) registry and divided into octogenarians group (OG, 551 patients) and nonoctogenarians (NOGs, 2,453 patients). Major adverse cardiovascular event (MACE), a composite end point of all‐cause death, nonfatal myocardial infarction (MI), target lesion revascularization (TLR), and stent thrombosis (ST), was the primary endpoint, while MACE components, cardiovascular (CV) death, and target vessel revascularization (TVR) were the secondary ones.
Results
Indication for PCI was acute coronary syndrome in 64.7% of the OG versus 53.1% of the NOG. Severe calcifications and a diffuse disease were significantly more in OG. After a follow‐up of 15.2 ± 10.3 months, MACEs were higher in the OG than in the NOG patients (OG 19.1% vs. NOG 11.2%, p |
| doi_str_mv | 10.1002/ccd.29048 |
| format | Article |
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Outcomes of complex percutaneous coronary interventions (PCIs) in older patients are still debated.
The aim of the study was to evaluate clinical outcomes of Octogenarian patients treated with ultrathinstents on left main or on coronary bifurcations, compared with younger patients.
Methods
All consecutive patients presenting a critical lesion of an unprotected left main (ULM) or a bifurcation and treated with very thin stents were included in the RAIN (veRy thin stents for patients with left mAIn or bifurcatioN in real life) registry and divided into octogenarians group (OG, 551 patients) and nonoctogenarians (NOGs, 2,453 patients). Major adverse cardiovascular event (MACE), a composite end point of all‐cause death, nonfatal myocardial infarction (MI), target lesion revascularization (TLR), and stent thrombosis (ST), was the primary endpoint, while MACE components, cardiovascular (CV) death, and target vessel revascularization (TVR) were the secondary ones.
Results
Indication for PCI was acute coronary syndrome in 64.7% of the OG versus 53.1% of the NOG. Severe calcifications and a diffuse disease were significantly more in OG. After a follow‐up of 15.2 ± 10.3 months, MACEs were higher in the OG than in the NOG patients (OG 19.1% vs. NOG 11.2%, p < .001), along with MI (OG 6% vs. NOG 3.4%, p = .002) and all‐cause death (OG 14% vs. NOG 4.3%, p < .001). In contrast, no significant difference was detected in CV‐death (OG 5.1% vs. NOG 4%, p = .871), TVR/TLR, or ST. At multivariate analysis, age was not an independent predictor of MACE (OR 1.02 CI 95% 0.76–1.38), while it was for all‐cause death, along with diabetes, GFR < 60 ml/min, and ULM disease.
Discussion
Midterm outcomes of complex PCI in OG are similar to those of younger patients. However, due to the higher non‐CV death rate, accurate patient selection is mandatory.</description><identifier>ISSN: 1522-1946</identifier><identifier>EISSN: 1522-726X</identifier><identifier>DOI: 10.1002/ccd.29048</identifier><identifier>PMID: 32478451</identifier><language>eng</language><publisher>Hoboken, USA: John Wiley & Sons, Inc</publisher><subject>Acute coronary syndromes ; Angioplasty ; bifurcations ; Death ; Diabetes mellitus ; elderly ; Implants ; left main ; Multivariate analysis ; Myocardial infarction ; octogenarians ; PCI ; Rain ; Stents ; Thrombosis</subject><ispartof>Catheterization and cardiovascular interventions, 2021-04, Vol.97 (5), p.755-763</ispartof><rights>2020 Wiley Periodicals LLC.</rights><rights>2021 Wiley Periodicals LLC.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c3138-c51da530fdde0fb780e1c70a00cf9e9b3ff0a07d758ccbe13e6ba457079871463</cites><orcidid>0000-0003-4164-2758 ; 0000-0001-6817-2923 ; 0000-0002-6646-9317</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fccd.29048$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fccd.29048$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27903,27904,45553,45554</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32478451$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Conrotto, Federico</creatorcontrib><creatorcontrib>D'Ascenzo, Fabrizio</creatorcontrib><creatorcontrib>Piroli, Francesco</creatorcontrib><creatorcontrib>Franzé, Alfonso</creatorcontrib><creatorcontrib>Luca, Leonardo</creatorcontrib><creatorcontrib>Quadri, Giorgio</creatorcontrib><creatorcontrib>Ryan, Nicola</creatorcontrib><creatorcontrib>Escaned, Javier</creatorcontrib><creatorcontrib>Bo, Mario</creatorcontrib><creatorcontrib>De Ferrari, Gaetano Maria</creatorcontrib><title>Percutaneous coronary intervention of unprotected left main and bifurcation in octogenarians: Subanalysis from RAIN (veRy thin stents for patients with left mAIn or bifurcatioN in real life)</title><title>Catheterization and cardiovascular interventions</title><addtitle>Catheter Cardiovasc Interv</addtitle><description>Objective
Outcomes of complex percutaneous coronary interventions (PCIs) in older patients are still debated.
The aim of the study was to evaluate clinical outcomes of Octogenarian patients treated with ultrathinstents on left main or on coronary bifurcations, compared with younger patients.
Methods
All consecutive patients presenting a critical lesion of an unprotected left main (ULM) or a bifurcation and treated with very thin stents were included in the RAIN (veRy thin stents for patients with left mAIn or bifurcatioN in real life) registry and divided into octogenarians group (OG, 551 patients) and nonoctogenarians (NOGs, 2,453 patients). Major adverse cardiovascular event (MACE), a composite end point of all‐cause death, nonfatal myocardial infarction (MI), target lesion revascularization (TLR), and stent thrombosis (ST), was the primary endpoint, while MACE components, cardiovascular (CV) death, and target vessel revascularization (TVR) were the secondary ones.
Results
Indication for PCI was acute coronary syndrome in 64.7% of the OG versus 53.1% of the NOG. Severe calcifications and a diffuse disease were significantly more in OG. After a follow‐up of 15.2 ± 10.3 months, MACEs were higher in the OG than in the NOG patients (OG 19.1% vs. NOG 11.2%, p < .001), along with MI (OG 6% vs. NOG 3.4%, p = .002) and all‐cause death (OG 14% vs. NOG 4.3%, p < .001). In contrast, no significant difference was detected in CV‐death (OG 5.1% vs. NOG 4%, p = .871), TVR/TLR, or ST. At multivariate analysis, age was not an independent predictor of MACE (OR 1.02 CI 95% 0.76–1.38), while it was for all‐cause death, along with diabetes, GFR < 60 ml/min, and ULM disease.
Discussion
Midterm outcomes of complex PCI in OG are similar to those of younger patients. However, due to the higher non‐CV death rate, accurate patient selection is mandatory.</description><subject>Acute coronary syndromes</subject><subject>Angioplasty</subject><subject>bifurcations</subject><subject>Death</subject><subject>Diabetes mellitus</subject><subject>elderly</subject><subject>Implants</subject><subject>left main</subject><subject>Multivariate analysis</subject><subject>Myocardial infarction</subject><subject>octogenarians</subject><subject>PCI</subject><subject>Rain</subject><subject>Stents</subject><subject>Thrombosis</subject><issn>1522-1946</issn><issn>1522-726X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNp1kdFqFDEUhgdRbK1e-AIS8Ka92PYkmUxmvFtWqwulSlXwbshkTmzKTLJNMi37cj5b051VRPAqOcnHd-D_i-I1hVMKwM607k9ZA2X9pDikgrGFZNWPp_s7bcrqoHgR4w0ANBVrnhcHnJWyLgU9LH59waCnpBz6KRLtg3cqbIl1CcMdumS9I96QyW2CT6gT9mRAk8iorCPK9aSzZgpa7cD85HXyPzE7rHLxHfk6dcqpYRttJCb4kVwt15fk-A6vtiRdZz6mvCT_-UA2WbIb7m263m9ZrrMy_LXk8nFJQDWQwRo8eVk8M2qI-Gp_HhXfzz98W31aXHz-uF4tLxaaU14vtKC9EhxM3yOYTtaAVEtQANo02HTcmDzIXopa6w4px6pTpZAgm1rSsuJHxfHszTHcThhTO9qocRjm4FpWQi24ANFk9O0_6I2fQg4hU4IyJqHkPFMnM6WDjzGgaTfBjjn6lkL7WGqbS213pWb2zd44dSP2f8jfLWbgbAbu7YDb_5va1er9rHwACSGu5w</recordid><startdate>20210401</startdate><enddate>20210401</enddate><creator>Conrotto, Federico</creator><creator>D'Ascenzo, Fabrizio</creator><creator>Piroli, Francesco</creator><creator>Franzé, Alfonso</creator><creator>Luca, Leonardo</creator><creator>Quadri, Giorgio</creator><creator>Ryan, Nicola</creator><creator>Escaned, Javier</creator><creator>Bo, Mario</creator><creator>De Ferrari, Gaetano Maria</creator><general>John Wiley & Sons, Inc</general><general>Wiley Subscription Services, Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-4164-2758</orcidid><orcidid>https://orcid.org/0000-0001-6817-2923</orcidid><orcidid>https://orcid.org/0000-0002-6646-9317</orcidid></search><sort><creationdate>20210401</creationdate><title>Percutaneous coronary intervention of unprotected left main and bifurcation in octogenarians: Subanalysis from RAIN (veRy thin stents for patients with left mAIn or bifurcatioN in real life)</title><author>Conrotto, Federico ; D'Ascenzo, Fabrizio ; Piroli, Francesco ; Franzé, Alfonso ; Luca, Leonardo ; Quadri, Giorgio ; Ryan, Nicola ; Escaned, Javier ; Bo, Mario ; De Ferrari, Gaetano Maria</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3138-c51da530fdde0fb780e1c70a00cf9e9b3ff0a07d758ccbe13e6ba457079871463</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Acute coronary syndromes</topic><topic>Angioplasty</topic><topic>bifurcations</topic><topic>Death</topic><topic>Diabetes mellitus</topic><topic>elderly</topic><topic>Implants</topic><topic>left main</topic><topic>Multivariate analysis</topic><topic>Myocardial infarction</topic><topic>octogenarians</topic><topic>PCI</topic><topic>Rain</topic><topic>Stents</topic><topic>Thrombosis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Conrotto, Federico</creatorcontrib><creatorcontrib>D'Ascenzo, Fabrizio</creatorcontrib><creatorcontrib>Piroli, Francesco</creatorcontrib><creatorcontrib>Franzé, Alfonso</creatorcontrib><creatorcontrib>Luca, Leonardo</creatorcontrib><creatorcontrib>Quadri, Giorgio</creatorcontrib><creatorcontrib>Ryan, Nicola</creatorcontrib><creatorcontrib>Escaned, Javier</creatorcontrib><creatorcontrib>Bo, Mario</creatorcontrib><creatorcontrib>De Ferrari, Gaetano Maria</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Catheterization and cardiovascular interventions</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Conrotto, Federico</au><au>D'Ascenzo, Fabrizio</au><au>Piroli, Francesco</au><au>Franzé, Alfonso</au><au>Luca, Leonardo</au><au>Quadri, Giorgio</au><au>Ryan, Nicola</au><au>Escaned, Javier</au><au>Bo, Mario</au><au>De Ferrari, Gaetano Maria</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Percutaneous coronary intervention of unprotected left main and bifurcation in octogenarians: Subanalysis from RAIN (veRy thin stents for patients with left mAIn or bifurcatioN in real life)</atitle><jtitle>Catheterization and cardiovascular interventions</jtitle><addtitle>Catheter Cardiovasc Interv</addtitle><date>2021-04-01</date><risdate>2021</risdate><volume>97</volume><issue>5</issue><spage>755</spage><epage>763</epage><pages>755-763</pages><issn>1522-1946</issn><eissn>1522-726X</eissn><abstract>Objective
Outcomes of complex percutaneous coronary interventions (PCIs) in older patients are still debated.
The aim of the study was to evaluate clinical outcomes of Octogenarian patients treated with ultrathinstents on left main or on coronary bifurcations, compared with younger patients.
Methods
All consecutive patients presenting a critical lesion of an unprotected left main (ULM) or a bifurcation and treated with very thin stents were included in the RAIN (veRy thin stents for patients with left mAIn or bifurcatioN in real life) registry and divided into octogenarians group (OG, 551 patients) and nonoctogenarians (NOGs, 2,453 patients). Major adverse cardiovascular event (MACE), a composite end point of all‐cause death, nonfatal myocardial infarction (MI), target lesion revascularization (TLR), and stent thrombosis (ST), was the primary endpoint, while MACE components, cardiovascular (CV) death, and target vessel revascularization (TVR) were the secondary ones.
Results
Indication for PCI was acute coronary syndrome in 64.7% of the OG versus 53.1% of the NOG. Severe calcifications and a diffuse disease were significantly more in OG. After a follow‐up of 15.2 ± 10.3 months, MACEs were higher in the OG than in the NOG patients (OG 19.1% vs. NOG 11.2%, p < .001), along with MI (OG 6% vs. NOG 3.4%, p = .002) and all‐cause death (OG 14% vs. NOG 4.3%, p < .001). In contrast, no significant difference was detected in CV‐death (OG 5.1% vs. NOG 4%, p = .871), TVR/TLR, or ST. At multivariate analysis, age was not an independent predictor of MACE (OR 1.02 CI 95% 0.76–1.38), while it was for all‐cause death, along with diabetes, GFR < 60 ml/min, and ULM disease.
Discussion
Midterm outcomes of complex PCI in OG are similar to those of younger patients. However, due to the higher non‐CV death rate, accurate patient selection is mandatory.</abstract><cop>Hoboken, USA</cop><pub>John Wiley & Sons, Inc</pub><pmid>32478451</pmid><doi>10.1002/ccd.29048</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0003-4164-2758</orcidid><orcidid>https://orcid.org/0000-0001-6817-2923</orcidid><orcidid>https://orcid.org/0000-0002-6646-9317</orcidid></addata></record> |
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| ispartof | Catheterization and cardiovascular interventions, 2021-04, Vol.97 (5), p.755-763 |
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| language | eng |
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| source | Wiley Online Library Journals Frontfile Complete |
| subjects | Acute coronary syndromes Angioplasty bifurcations Death Diabetes mellitus elderly Implants left main Multivariate analysis Myocardial infarction octogenarians PCI Rain Stents Thrombosis |
| title | Percutaneous coronary intervention of unprotected left main and bifurcation in octogenarians: Subanalysis from RAIN (veRy thin stents for patients with left mAIn or bifurcatioN in real life) |
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