Author + information
- Shawn X. Li,
- Jiyong Lee,
- Hannah Chaudry,
- Theodore Curran,
- Vishesh Kumar,
- Bruce Andrus and
- James DeVries
The very elderly are the fastest growing segment of the US population. Decisions regarding PCI in the elderly will need to be made with increasing frequency in the future, and there is uncertainty whether age alone should be used to limit access to PCI. Previous studies have shown that very elderly patients have higher bleeding risks and mortality, but it is unclear at what age these risks become prohibitive. This study aims to describe the relationship between age and in-hospital mortality and post-procedural bleeding.
The Dartmouth Dynamic Registry was queried for all consecutive PCI cases between the years 2000-2015. Patients were grouped based on age. Demographic, procedural, and in-hospital outcomes were analyzed. Bleeding requiring transfusion and mortality were reported as running averages by ten year increments of age. Standard statistical methods were used to report outcomes.
Between 2000-2015, 17,599 patients underwent PCI. The average patient age was 65, and 28% were female. Incidence of smoking, hypertension, hypercholesterolemia, and CKD were 50%, 69%, 67%, 29%, and 10% respectively. Figure 1 demonstrates the relationship of age with both bleeding requiring transfusion and mortality. Bleeding and mortality risks remain relative constant until the age of 70, at which point risks for both rise in a linear fashion. The most elderly patients (age >90) have the highest risk of both bleeding and mortality.
For patients up to age 70, there is no increased risk of bleeding or mortality with increasing age. Above age 70, there is a rapid increase in both bleeding and mortality. Efforts to better understand and mitigate the increased risk in this rapidly growing population are warranted.