In hospital and long-term outcomes after percutaneous coronary intervention for chronic total occlusions in elderly patients: a consecutive prospective monocentric study
Bibliographic record
Abstract
Introduction: Nowadays, elderly patients with more complex coronary artery diseases are increasingly referred for percutaneous coronary intervention (PCI). Despite progress over the last decade, percutaneous treatment of chronic total occlusions (CTO) remains one of the major challenges in contemporary interventional cardiology. The complexity of such PCI is illustrated by their relatively low success rates and by an increased risk of post operative complications. The aim of our study was to assess feasibility, safety and benefits associated with CTO-PCI for elderly patients. Method: Within a consecutive cohort of 374 patients who underwent CTO PCI in our institution between January 2008 and December 2011, we analyzed the rates of successful recanalization and the rates of post-operative complications according to age of patients. Elders were over 75 and post-operative complications were defined by death, re-infarction, stroke and coronary arterial bypass surgery (CABG) within 30 days. In both groups, benefits of revascularization were evaluated at 18-month by assessment of major adverse cardiac events according to the issue of initial procedure. Major adverse cardiac events were defined by death, infarction, new PCI or CABG. Results: Among the cohort, 68% (n=254) of patients were admitted for stable symptomatic coronary artery disease (angina or silent ischemia) despite optimal medical therapy whereas 32% (n=120) were admitted for an acute coronary syndrome (ACS) involving another vessel than CTO vessel. Even if elders (n=98) presented more complex coronary arterial diseases, 74.5% (n=73) of them benefited from a successful percutaneous recanalization. This procedural success rate was comparable to the one recorded in youngers (78.3% p=0.444). As attended post-operative complications were more frequent in elders (7.45% vs. 0.73% p=0.001), but this complications rate remain reasonable considering this high risk population (Median Euroscore I at 9[7-11]). Among elders, we recorded 2 death for patients admitted with an ACS, and 3 post-procedure myocardial infarctions. Two patients undergone CABG within 30 days, but it was an elective surgery in each case. At 18-month survival analysis revealed that prognosis was better if patients had a successful revascularization, whatever their age was (p=0.019 for elders& p=0.008 for youngers). Conclusion: Elderly patients have more complex coronary artery disease, but CTO PCI was achieved with same success rate than for younger patients. At 18-month, a CTO PCI success improves survival.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".