Background: Coronary lesion complexity may influence cardiovascular outcomes after percutaneous coronary intervention (PCI). This effect has not been specifically investigated in very elderly patients, particularly with respect to both clinical and symptomatic outcomes. This substudy of the Cruz Senior trial aimed to evaluate the relationship between lesion complexity cardiovascular events, and patient-reported outcomes in octogenarian and nonagenarian all-comer patients with coronary artery disease.
Methods: This prospective, multicentre, observational study enrolled patients of age ≥80 years, across 37 sites in Europe. All-comer patients with acute coronary syndrome, stable angina, or silent ischemia undergoing percutaneous coronary intervention were included. Follow-up was performed over 12 months and assessed clinical outcomes, quality of life and frailty markers. The primary endpoint at 12 months was a device-oriented composite (DOCE) comprising cardiovascular death, myocardial infarction not attributable to a non-target vessel, and clinically driven target lesion revascularization. Secondary endpoints included individual components of the primary endpoint and quality of life measures (Seattle Angina Questionnaire - SAQ, PROMIS-29).
Lesions were classified as complex, whenever at least one of the following criteria was fulfilled: ≥ 3 stents implanted or ≥ 2 stents implanted within a bifurcation or total stent length >60mm or ≥ 3 lesions treated or total occlusion or multivessel PCI.
Results: A total of 1993 octo- and nonagenarian patients with CAD were included, with a mean age of 84.3 years and 38.2 % (n =762) being female. 26.4 % (n = 519) of the patients had lesions that were classified as complex. The primary endpoint occurred more frequently in patients undergoing complex PCI as compared to non-complex PCI (11.2 vs. 6.8%; HR = 1.73; 95 CI = 1.23-2.44). Within the entire study cohort, an overall improvement of symptoms was detected when comparing the SAQ summary score between baseline and follow up (BL = 65.8 vs. FU = 72.7, p < 0.0001). When comparing patients with complex and non-complex lesions no relevant differences were detected in baseline symptomatic burden (SAQ summary score 74.2 vs. 72.2; p = n.s.) and absolute difference between baseline and follow up (8.3 vs. 5.9; p = n.s.). However, patients undergoing PCI after acute coronary syndrome (8.7 vs. 5.8; p < 0.05) and left main treatment (11.5 vs. 6.3; p < 0.05) displayed significantly stronger symptomatic improvements as compared to patients without these features.
Conclusion: Elderly patients undergoing complex PCI display higher rates of clinical events. With regards to symptomatic improvement specific subgroups (LM-treatment and ACS) display the strongest benefit. Overall, these findings may assist in optimized patient selection for PCI in elderly patients.
