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Posted by on Nov 28, 2016 in Coronary artery disease | 0 comments

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In a nutshell

This paper studied the need for a repeat procedure after a percutaneous coronary intervention (PCI) in elderly patients. The authors developed a model to predict the risk of a repeat procedure following a failed PCI.

Some background

Percutaneous coronary intervention (PCI) is a procedure done to improve blood supply to the heart. PCI is an increasingly used treatment of narrowing blood vessels. It can be done through bare-metal stents (mesh wire tubes) that widen up narrowed blood vessels. Drug-eluting stent (mesh wire tube that releases medicine) can also be used, although it is more expensive and has been associated with a risk for bleeding. Some PCI procedures can fail. This means there needs to be a repeat PCI procedure, also known as revascularization. The occurrence of revascularization on the same blood vessel is not well studied in elderly patients.

Methods & findings

The records of 343,173 patients aged 65 and older treated with PCI were analyzed. Of these, 3.3% had revascularization on the same blood vessel within one year of a PCI. Overall, 76.5% of patients were treated with a drug-eluting stent. Patients with bare-metal stents were compared against patients with drug-eluting stents. 
 
Diabetes, and a previous PCI procedure were found to increase the risk of revascularization. PCI for multiple blood vessels and a smaller stent diameter were also found to increase the risk. Using these factors, the authors developed a model to predict the risk of revascularization.
 
The authors classified patients according to their risk of revascularization. For high-risk patients, the use of a drug-eluting stent reduced the rate of revascularization by 35.5% compared to the use of a bare-metal stent. In low risk patients, a drug-eluting stent had a 0.9% lower risk of revascularization compared to bare-metal stent. In medium risk patients, a drugs eluting stent had a 1.4% lower risk of revascularization.

The bottom line

The authors concluded that elderly patients treated with PCI can be classified into groups that predict the risk of revascularization. This may inform the clinical decision-making regarding the type of stent used.

The fine print

Other factors not used in the model for prediction could also contribute to risk. 

Published By :

American heart journal

Date :

Apr 01, 2014

Original Title :

Predicting target vessel revascularization in older patients undergoing percutaneous coronary intervention in the drug-eluting stent era.

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