Transradial approach limits PCI complications in oldest patients

The older patients get, the higher their risk of death or bleeding after percutaneous coronary intervention (PCI). But a new study from a Japanese PCI registry suggests a transradial approach can prevent some of those complications, particularly in nonagenarians.

Yohei Numasawa, MD, PhD, and colleagues studied 562,640 patients in their 60s or older who received PCI between 2014 and 2016 at more than 1,000 Japanese hospitals. The patients were broken up by age group in 10-year increments, and the cohort included more than 10,000 patients older than 90.

The risk of bleeding and in-hospital mortality was higher as the age groups progressed. Compared to individuals in their 60s, nonagenarians who received PCI for acute coronary syndrome (ACS) were 3.60 times more likely to die and 1.79 times more likely to have bleeding complications. When PCI was performed in the setting of stable coronary artery disease (CAD), patients in their 90s were 6.24 times more likely to die and 2.70 times more likely to have bleeding complications versus those in their 60s.

“Because patients with ACS are at high risk regardless of age and PCI is associated with better outcomes, even in elderly patients, undergoing PCI in patients with presentation of ACS may be reasonable, even in selected nonagenarians,” Numasawa, with Japanese Red Cross Ashikaga Hospital, and co-authors wrote in the Journal of the American Heart Association. “By contrast, taking the higher (odds ratios) for adverse outcomes in nonagenarians into account, indications of PCI for stable CAD in old patients should be considered carefully.”

There was a bit of encouraging news in the study for older PCI patients. Transradial intervention (TRI) was linked to a 59 percent decreased risk of mortality and a 62 percent decreased risk of bleeding in ACS patients, and a 73 percent decreased risk of mortality and 87 percent decreased risk of bleeding in non-ACS patients.

“Taking these study results into account, TRI plays a pivotal role in current PCI practice and should be especially considered for elderly patients with a high risk of bleeding,” the authors wrote, who added their study was the largest to date to report in-hospital outcomes after PCI in older patients, including those in their 80s and 90s.

However, they acknowledged the research was limited by its observational nature, lack of long-term follow-up data and lack of information about patients’ quality of life, which is an important post-PCI outcome. Also, the researchers didn't have precise information about the perioperative medical therapies patients were taking, which also could have influenced outcomes.