Health Status Outcomes in Older Adults Undergoing Chronic Total Occlusion Percutaneous Coronary Intervention

• Type of Material: Article
• Authors: William Nicholson, Emory University; Dan D Nguyen, Saint Luke’s Mid America Heart Institute; Kensey L Gosch, Saint Luke’s Mid America Heart Institute; Rayan El-Zein, Saint Luke’s Mid America Heart Institute; Paul S Chan, Saint Luke’s Mid America Heart Institute; William L Lombardi, University of Washington; Dimitri Karmpaliotis, Morristown Medical Center; John A Spertus, Saint Luke’s Mid America Heart Institute; Michael R Wyman, Torrance Memorial Medical Center; Jeffrey W Moses, Columbia University; Aaron J Grantham, Saint Luke’s Mid America Heart Institute; Adam C Salisbury, Saint Luke’s Mid America Heart Institute
• Language: English
• Date: 2023-02-07
• Publisher: WILEY
• Publication Version: Final Published Version
• Copyright Statement: © 2023 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1161/JAHA.122.027915
• Title of Journal or Parent Work: JOURNAL OF THE AMERICAN HEART ASSOCIATION
• Volume: 12
• Issue: 3
• Start Page: e027915
• End Page: e027915
• Grant/Funding Information: Drs. Nguyen and El‐Zein are currently supported by the National Heart, Blood and Lung Institutes of Health under Award Number T32H110837. Dr Chan receives research funding from the National Heart, Lung, and Blood Institute R01HL160734. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
• Keywords: SEX; MYOCARDIAL-INFARCTION; Science & Technology; SEATTLE ANGINA QUESTIONNAIRE; Life Sciences & Biomedicine; chronic total occlusion; AGE; MANAGEMENT; Cardiovascular System & Cardiology; Cardiac & Cardiovascular Systems; older adults; IMPACT; CLINICAL-OUTCOMES; percutaneous coronary intervention; RISK; health status
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

BACKGROUND: Although chronic total occlusions (CTOs) are common in older adults, they are less likely to be offered CTO percutaneous coronary intervention for angina relief than younger adults. The health status impact of CTO percutaneous coronary intervention in adults aged ≥75 years has not been studied. We sought to compare technical success rates and angina-related health status outcomes at 12 months between adults aged ≥75 and <75 years in the OPEN-CTO (Outcomes, Patient Health Status, and Efficiency in Chronic Total Occlusion) registry. METHODS AND RESULTS: Angina-related health status was assessed with the Seattle Angina Questionnaire (score range 0–100, higher scores denote less angina). Technical success rates were compared using hierarchical modified Poisson regression, and 12-month health status was compared using hierarchical multivariable linear regression between adults aged ≥75 and <75 years. Among 1000 participants, 19.8% were ≥75 years with a mean age of 79.5±4.1 years. Age ≥75 years was associated with a lower likelihood of technical success (adjusted risk ratio=0.92 [95% CI, 0.86–0.99; P=0.02]) and numerically higher rates of in-hospital major adverse cardiovascular events (9.1% versus 5.9%, P=0.10). There was no difference in Seattle Angina Questionnaire Summary Score at 12 months between adults aged ≥75 and <75 years (adjusted difference=0.9 [95% CI, −1.4 to 3.1; P=0.44]). CONCLUSIONS: Despite modestly lower success rates and higher complication rates, adults aged ≥75 years experienced angina-related health status benefits after CTO-percutaneous coronary intervention that were similar in magnitude to adults aged <75 years. CTO percutaneous coronary intervention should not be withheld based on age alone in otherwise appropriate candidates.