036 In-hospital outcomes of very elderly patients (over 85 years old) undergoing percutaneous coronary intervention:
Notice bibliographique
Résumé
<h3>Background</h3> Interventionists are often reluctant to undertake PCI in very elderly patients due to the perception of poor outcome in a high risk cohort. Paradoxically however, elderly patients may benefit most from revascularisation because of their higher baseline risk compared to younger patients. The prognostic significance of advanced age itself is not clear. <h3>Objective</h3> An observational study determining the in-hospital outcomes of very elderly patients (age>85) undergoing percutaneous coronary intervention (PCI) for all indications at a tertiary cardiac referral centre. <h3>Methods</h3> Baseline clinical, angiographic and procedural variables and in-hospital outcome data were entered into a prospective registry of 17 572 consecutive patients undergoing PCI at the University Health Network between April 2000 and December 2008. Patients were stratified according to age (<85 years, n=17 168, or ≥85 years, n=404) and in-hospital mortality, major adverse cardiac event (MACE) and complication rates were calculated. Logistic regression-analysis identified independent predictors of unadjusted mortality and MACE. Very elderly patients were propensity matched (1:2 ratio) with younger patients, and the analysis repeated. <h3>Results</h3> Very elderly patients had a mean age of 87.5±2.9 (range 85 to 97) vs 62.8±11.1 years for the younger cohort and had greater comorbidity. The very elderly were more likely to present as a primary or urgent PCI, and PCI was less likely to be undertaken electively. Left main stem and complex lesion-type intervention was greater, and angiographic success less likely. Unadjusted mortality and post procedure MI were significantly higher (6.93% vs 1.20%, p<0.0001 and 4.46% vs 2.74%, p=0.04), but CABG rates did not significantly differ (0.25% vs 0.47%, p=0.5). Length of stay, renal, neurological and access-site complications were all greater in the very elderly cohort. Though age≥85 years was a significant independent predictor of both mortality (OR 2.62, CI 1.44 to 4.78, p=0.0016) and MACE (OR 1.94, CI 1.25 to 3.01, p=0.003), its effect was not as great as other well documented variables such as cardiogenic shock and urgency of procedure. After propensity matching, mortality remained significantly higher in the very elderly patients (7.0% vs 3.25%, p=0.003). MACE rates were also significantly higher (9.75% vs 5.88%, p=0.014). Advanced age remained a strong predictor of worse outcomes (mortality OR 2.90, CI 1.38 to 6.06, p=0.005, MACE OR 2.01, CI 1.17 to 3.46, p=0.011). <h3>Conclusion</h3> Very elderly patients represent a high risk cohort in terms of comorbidity and complications post-PCI. Although in-hospital mortality was significantly increased compared with younger patients, death occurred predominantly in very elderly patients undergoing non-elective PCI. Decisions to proceed with PCI in very elderly patients should be based on other prognostic variables and these patients should not be excluded from revascularization based on age alone.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; les deux têtes enseignantes s’accordent sur ce qui est montré ici.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».