THE RESULTS OF PERCUTANEOUS INTERVENTIONS IN CHRONIC OCCLUSION OF THE CORONARY ARTERIES IN PATIENTS OF THE SENILE AGE GROUP

Highlights

• This study contributes to the subject area and is new due to the fact that the senile group of patients remains the least studied group in relation to revascularization of chronic coronary artery occlusions.
• The results obtained will help to form a more complete picture regarding the safety and expediency of using percutaneous coronary intervention in chronic occlusion of the coronary arteries in this group of patients.

Resume

Aim. To perform a comparative analysis of the hospital results of planned percutaneous coronary intervention in chronic occlusion of the coronary arteries in patients of the senile age group (≥75) and in patients of the elderly age group (up to 74 years).

Methods. In this retrospective study, the results of PCI in the treatment of patients of the senile age group (n = 58) and younger patients (n = 478) were analyzed. The sampling was carried out using a continuous method. Endpoints of the study: mortality from all causes, mortality from cardiac causes, myocardial infarction, acute cerebrovascular accident, repeated unplanned revascularization, combined endpoint. 

Results. A feature of the groups was the age of the included patients who underwent PCI in HOCA. In the control group, patients < 75 years of age were considered, as the main group – patients of the senile age group ≥ 75 years. Most of the interventions were successful (74.6% and 75.8%, p = 0.972, respectively). There were no differences in the frequency of complications, hospital mortality from all causes in the control group was 1 case (0.209%) and 0 in the senile group, p = 0.207, mortality from non-cardiac causes in the control group was 1 case (0.209%) and 0 in the senile group, p = 0.207, emergency postoperative PCI in the control group There was 1 case (0.209%) and 0 in the senile group, p = 0.207, the mortality rate of cardiac causes was zero in both groups. The senile group showed a low percentage of complications: hemopericardium in the control group 6 (1.25%), in the senile group 0, p = 0.844, coronary artery perforation 25 (5.2%) and 1 (1.72%), p = 0.395, intraoperative coronary artery dissection requiring implantation 14 (2.92%) and 1 (1.72%), p = 0.917.

Conclusion. The use of PCI in HOCA on a planned basis in patients with preserved left ventricular ejection fraction of the senile age group ≥ 75 years demonstrated comparable success results, low rates of intraoperative and postoperative complications with PCI in HOCA in people aged < 75 years, which indicates the safety of PCI in HOCA for senile patients and may be the method of choice.

1. Nowbar AN, Gitto M, Howard JP, Francis DP, Al-Lamee R. Mortality From Ischemic Heart Disease. Circ Cardiovasc Qual Outcomes. 2019;12(6):e005375. doi:10.1161/CIRCOUTCOMES.118.005375

2. Shabunov A.A., Barsukov V.N. Tendentsii demograficheckogo starenija naselenija Rossiyskoy Federatsyi i puti ih preodoleniya. [Demographic aging trends in the Russian Federation and ways to overcome them]. Available at: http://pdt.vscc.ac.ru/article/1228/full?_lang=ru (accessed 06.05.2024) (In Russ.)

3. Albaeni A, Chatila KF, Thakker RA, et al. In-Hospital Outcomes of Chronic Total Occlusion Percutaneous Coronary Interventions in Heart failure patients. Curr Probl Cardiol. 2023;48(2):101458. doi:10.1016/j.cpcardiol.2022.101458

4. Batluk T.I., Tarlovskaya E.I., Arutyunov G.P., Koziolova N.A., Chesnikova A.I., Barbarash O.L., Arutyunov A.G. Clinical registry on patient population with multifocal atherosclerosis in the Russian Federation and Eurasian countries – Kamma. Complex Issues of Cardiovascular Diseases. 2023;12(2):6-13. (In Russ.)

5. Lateef N, Ahsan MJ, Fazeel HM, et al. Percutaneous coronary intervention for chronic total occlusion in patients aged <75 years versus ≥75 years: a systematic review. J Community Hosp Intern Med Perspect. 2020;10(1):25-31. Published 2020 Feb 10. doi:10.1080/20009666.2020.1719731.

6. Guo L, Lv HC, Huang RC. Percutaneous Coronary Intervention in Elderly Patients with Coronary Chronic Total Occlusions: Current Evidence and Future Perspectives. Clin Interv Aging. 2020;15:771-781. Published 2020 May 28. doi:10.2147/CIA.S252318

7. Guo L, Lv H, Zhong L, et al. Comparison of long-term outcomes of medical therapy and successful recanalisation for coronary chronic total occlusions in elderly patients: a report of 1,294 patients. Cardiovasc Diagn Ther. 2019;9(6):586-595. doi:10.21037/cdt.2019.11.01.

8. Zhao S, Wang J, Chen Y, et al. Improvement of Symptoms and Quality of Life After Successful Percutaneous Coronary Intervention for Chronic Total Occlusion in Elderly Patients. J Am Heart Assoc. 2023;12(8):e029034. doi:10.1161/JAHA.123.029034

9. Valenti R, Migliorini A, De Gregorio MG, et al. Impact of complete percutaneous revascularization in elderly patients with chronic total occlusion. Catheter Cardiovasc Interv. 2020;95(1):145-153. doi:10.1002/ccd.28452.

10. Su YM, Pan M, Geng HH, Zhang R, Qu YY, Ma GS. Outcomes after percutaneous coronary intervention and comparison among scoring systems in predicting procedural success in elderly patients (≥ 75 years) with chronic total occlusion. Coron Artery Dis. 2019;30(7):481-487. doi:10.1097/MCA.0000000000000765.

11. Azzalini L, Hirai T, Salisbury A, et al. Validation of the new PROGRESS-CTO complication risk scores in the OPEN-CTO registry. Catheter Cardiovasc Interv. 2023;101(3):536-542. doi:10.1002/ccd.30563.

12. Gu D, Qu J, Zhang H, Zheng Z. Revascularization for Coronary Artery Disease: Principle and Challenges. Adv Exp Med Biol. 2020;1177:75-100. doi:10.1007/978-981-15-2517-9_3

13. Damluji AA, Forman DE, Wang TY, et al. Management of Acute Coronary Syndrome in the Older Adult Population: A Scientific Statement From the American Heart Association. Circulation. 2023;147(3):e32-e62. doi:10.1161/CIR.0000000000001112

14. Lee SW, Lee PH, Ahn JM, et al. Randomized Trial Evaluating Percutaneous Coronary Intervention for the Treatment of Chronic Total Occlusion. Circulation. 2019;139(14):1674-1683. doi:10.1161/CIRCULATIONAHA.118.031313.

15. Simsek B, Gorgulu S, Kostantinis S, et al. Radial access for chronic total occlusion percutaneous coronary intervention: Insights from the PROGRESS-CTO registry. Catheter Cardiovasc Interv. 2022;100(5):730-736. doi:10.1002/ccd.30347.

16. Cui C, Sheng Z. Outcomes of percutaneous coronary intervention for chronic total occlusions in the elderly: A systematic review and meta-analysis. Clin Cardiol. 2021;44(1):27-35. doi:10.1002/clc.23524.

17. Agrawal H, Lange RA, Montanez R, et al. The Role of Percutaneous Coronary Intervention in the Treatment of Chronic Total Occlusions: Rationale and Review of the Literature. Curr Vasc Pharmacol. 2019;17(3):278-290. doi:10.2174/1570161116666180117100635

18. Gimbel ME, Willemsen LM, Daggelders MC, et al. Long-term follow-up after bypass surgery or coronary stenting in elderly with multivessel disease. Neth Heart J. 2020;28(9):467-477. doi:10.1007/s12471-020-01415-z.

19. Numasawa Y, Inohara T, Ishii H, et al. Comparison of Outcomes After Percutaneous Coronary Intervention in Elderly Patients, Including 10 628 Nonagenarians: Insights From a Japanese Nationwide Registry (J-PCI Registry). J Am Heart Assoc. 2019;8(5):e011183. doi:10.1161/JAHA.118.011017.

20. Valenti R, Migliorini A, De Gregorio MG, et al. Impact of complete percutaneous revascularization in elderly patients with chronic total occlusion. Catheter Cardiovasc Interv. 2020;95(1):145-153. doi:10.1002/ccd.28452.

21.