Predicting target vessel revascularization in older patients undergoing percutaneous coronary intervention in the drug-eluting stent era.
Journal Article
Background
The contemporary need for repeat revascularization in older patients after percutaneous coronary intervention (PCI) has not been well studied. Understanding repeat revascularization risk in this population may inform treatment decisions.Methods
We analyzed patients ≥65 years old undergoing native-vessel PCI of de novo lesions from 2005 to 2009 discharged alive using linked CathPCI Registry and Medicare data. Repeat PCIs within 1 year of index procedure were identified by claims data and linked back to CathPCI Registry to identify target vessel revascularization (TVR). Surgical revascularization and PCIs not back linked to CathPCI Registry were excluded from main analyses but included in sensitivity analyses. Independent predictors of TVR after drug-eluting stent (DES) or bare-metal stent (BMS) implantation were identified by multivariable logistic regression.Results
Among 343,173 PCI procedures, DES was used in 76.5% (n = 262,496). One-year TVR ranged from 3.3% (overall) to 7.1% (sensitivity analysis). Precatheterization and additional procedure-related TVR risk models were developed in BMS (c-indices 0.54, 0.60) and DES (c-indices 0.57, 0.60) populations. Models were well calibrated and performed similarly in important patient subgroups (female, diabetic, and older [≥75 years]). The use of DES reduced predicted TVR rates in high-risk older patients by 35.5% relative to BMS (from 6.2% to 4.0%). Among low-risk patients, the number needed to treat with DES to prevent 1 TVR was 63-112; among high-risk patients, this dropped to 28-46.Conclusions
In contemporary clinical practice, native-vessel TVR among older patients occurs infrequently. Our prediction model identifies patients at low versus high TVR risk and may inform clinical decision making.Full Text
Duke Authors
Cited Authors
- Hess, CN; Rao, SV; Dai, D; Neely, ML; Piana, RN; Messenger, JC; Peterson, ED
Published Date
- April 2014
Published In
Volume / Issue
- 167 / 4
Start / End Page
- 576 - 584.e2
PubMed ID
- 24655708
Pubmed Central ID
- 24655708
Electronic International Standard Serial Number (EISSN)
- 1097-6744
International Standard Serial Number (ISSN)
- 0002-8703
Digital Object Identifier (DOI)
- 10.1016/j.ahj.2013.12.017
Language
- eng