https://doi.org/10.1007/s00392-025-02625-4
1Segeberger Kliniken GmbH Herz- und Gefäßzentrum Bad Segeberg, Deutschland; 2Segeberger Kliniken GmbH Herzzentrum Bad Segeberg, Deutschland; 3Universitätsklinikum Schleswig-Holstein Medizinische Klinik II / Kardiologie, Angiologie, Intensivmedizin Lübeck, Deutschland; 4Klinikum Oldenburg AöR Klinik für Kardiologie Oldenburg, Deutschland; 5Asklepios Klinik Bad Oldesloe Zentrum für Herz-, Gefäß- und Diabetesmedizin Bad Oldesloe, Deutschland; 6Segeberger Kliniken GmbH Kardiologie und Angiologie Bad Segeberg, Deutschland; 7Asklepios Klinik Bad Oldesloe Kardiologie Bad Oldesloe, Deutschland
Background: Elderly patients often present with complex coronary artery disease (CAD) and multiple comorbidities. Moreover, the prevalence of chronic total occlusion (CTO) increases with age. There is limited data on the outcomes following percutaneous coronary intervention (PCI) for CTO in octogenarians.
Aim: To investigate the in-hospital and one-year outcomes following CTO-PCI in octogenarian patients.
Methods: A total of 778 patients who had CTO-PCI between 2017 and 2022 at a single center were enrolled in the current study. Patients aged 90 years or older were excluded. The population was divided into two groups: octogenarian patients (age ≥ 80 years, n=120) and a control group (age < 80 years, n=658). In-hospital major adverse outcomes were defined as a composite of cardiac death, peri-procedural myocardial infarction (MI) and stroke/transient ischemic attacks. Periprocedural complications included vessel perforation, emergency coronary artery bypass graft surgery (CABG), severe bleeding, tamponade, contrast induced nephropathy (CIN), or persistent slow flow at the end of procedure. After one year of follow-up, major adverse cardiac event (MACE), defined as a composite endpoint of cardiac death, myocardial infarction (MI), or target vessel revascularization (TVR), was evaluated.
Results: A total of 120 patients (15.4%) were octogenarians, and 76% of the study population were male (p=0.008). Octogenarians presented more often with three-vessel CAD (70% vs 55.3%, p=0.010), calcified CAD (68.8% vs 56.5%, p=0.027), and had a higher rates of atrial fibrillation (29.1% vs 12%, p<0.001), and chronic kidney disease (33.3% vs 14.4%, p<0.001) than the control group. Retrograde technique was used in 9.8% of octogeneric and 12.9% of the control group (p=0.376). The rate of failed CTO-recanalization was higher in the octogeneric group (15% vs 8.4%, p=0.027). The in-hospital adverse outcome (18.5% vs. 13.8%, p=0.354) and periprocedural complications (13.7% vs. 15.3%, p=0.687) were comparable between the study groups. Notably, the octogeneric group showed higher rates of post-procedural CIN (11.9% vs 5.2%, p=0.010). After one-year, the MACE rate was 14.5% vs. 16.6% in the octogenarian vs. Control group (log rank p=0.995). In a multivariate analysis, atrial fibrillation, total stent length and periprocedural complications emerged as independent predictors for the one-year MACE.
Conclusion: Success rates for CTO recanalization were lower in octogenarians than in younger patients. However, aside from a higher incidence of contrast-induced nephropathy (CIN), octogenarians experienced similar periprocedural complications, in-hospital outcomes, and one-year adverse outcomes as their younger counterparts undergoing CTO PCI.