An analysis of more than 3.5 million percutaneous coronary intervention (PCI) patients found the procedure was initially popular with an older demographic starting in 1998, but after 2006 the overall number of PCIs in those aged 70 and up started to decline.
“Over the past few decades, there has been an increase in life expectancy, and elderly have been constituting a bigger subset of patients with coronary artery disease (CAD),” first author Ayman Elbadawi, MD, and eight coauthors wrote in the American Journal of Cardiology. “Available data on the trend and outcomes of PCI in elderly patients with CAD are limited, and comes mainly from single-centered or small multi-centered registries.”
Elbadawi, of the University of Texas Medical Branch, and colleagues studied Nationwide Inpatient Sample (NIS) data to better understand those trends, considering information logged between 1998 and 2013. In that window, the team identified 3,597,119 patients aged 70 or older who underwent PCI in the U.S., either with a bare-metal or drug-eluting stent.
The overall number of PCIs in older patients increased between 1998 and 2013—from 151,752 cases to 165,260, or an increase of 9 percent. Between 1998 and 2006 the authors observed a significant yearly increase of 18,329 procedures a year, but between 2006 and 2013 the field saw an average decrease of 33,614 PCIs per year.
“Such decline in PCI volumes was temporarily related to publication of major trials such as the COURAGE trial and the BARI 2D trial, which failed to show a mortality benefit of PCI over optimal medical therapy in patients with stable ischemic heart disease,” Elbadawi et al. explained. “While NIS only records inpatient procedures, the shift toward more outpatient PCI procedures might have contributed to the observed downward trend after 2006.”
The authors said the downward trend could also be the result of the adoption of appropriate use criteria for PCI, the adoption of fractional flow reserve-guided PCI and the shift toward increased intervention in elderly patients with more comorbidities.
In addition to the overall decrease in PCIs, patients in the study also saw a 2.6 percent in-hospital mortality rate in 1998 compared to a 3 percent mortality rate in 2013.
“Many useful data for our study could not be retrieved that include clinical variables, medications information, laboratory data and long-term outcomes,” they wrote. “Despite these limitations, this study fills the current gap in literature regarding the true volume and outcomes of PCI in the elderly in the United States.”