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Comparison of the use of hemodynamic support in patients ≥80 years versus patients <80 years during high-risk percutaneous coronary interventions (from the Multicenter PROTECT II Randomized Study).

Publication ,  Journal Article
Pershad, A; Fraij, G; Massaro, JM; David, SW; Kleiman, NS; Denktas, AE; Wilson, BH; Dixon, SR; Ohman, EM; Douglas, PS; Moses, JW; O'Neill, WW
Published in: Am J Cardiol
September 1, 2014

The outcomes of hemodynamic support during high-risk percutaneous coronary intervention in the very elderly are unknown. We sought to compare outcomes between the patients ≥80 years versus patients <80 years enrolled in the PROTECT II (Prospective Randomized Clinical Trial of Hemodynamic Support with the Impella 2.5 versus Intra-Aortic Balloon Pump in Patients undergoing High Risk Percutaneous Coronary Intervention) randomized trial. Patients who underwent high-risk percutaneous coronary intervention with an unprotected left main or last patent conduit and a left ventricular ejection fraction ≤35% or with 3-vessel disease and a left ventricular ejection fraction ≤30% were randomized to receive an intra-aortic balloon pump or the Impella 2.5; 90-day (or the longest follow-up) outcomes were compared between patients ≥80 years (n = 59) and patients <80 years (n = 368). At 90 days, the composite end point of major adverse events and major adverse cerebral and cardiac events were similar between patients ≥80 and <80 years (45.6% vs 44.1%, p = 0.823, and 23.7% vs 26.8%, p = 0.622, respectively). There were no differences in death, stroke, or myocardial infarction rates between the 2 groups, but fewer repeat revascularization procedures were required in patients ≥80 years (1.7% vs 10.4%, p = 0.032). Bleeding and vascular complication rates were low and comparable between the 2 age groups (3.4% vs 2.4%, p = 0.671, and 6.8% vs 5.4%, p = 0.677, respectively). Multivariate analysis confirmed that age was not an independent predictor of major adverse events (odds ratio = 1.031, 95% confidence interval 0.459-2.315, p = 0.941), whereas Impella 2.5 was an independent predictor for improved outcomes irrespective of age (odds ratio = 0.601, 95% confidence interval 0.391-0.923, p = 0.020). In conclusion, the use of percutaneous circulatory support is reasonable and feasible in a selected octogenarian population with similar outcomes as those of younger selected patients. Irrespective of age, the use of Impella 2.5 was an independent predictor of favorable outcomes.

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Published In

Am J Cardiol

DOI

EISSN

1879-1913

Publication Date

September 1, 2014

Volume

114

Issue

5

Start / End Page

657 / 664

Location

United States

Related Subject Headings

  • Ventricular Function, Left
  • United States
  • Treatment Outcome
  • Survival Rate
  • Risk Factors
  • Reoperation
  • Prospective Studies
  • Postoperative Complications
  • Percutaneous Coronary Intervention
  • Middle Aged
 

Citation

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Pershad, A., Fraij, G., Massaro, J. M., David, S. W., Kleiman, N. S., Denktas, A. E., … O’Neill, W. W. (2014). Comparison of the use of hemodynamic support in patients ≥80 years versus patients <80 years during high-risk percutaneous coronary interventions (from the Multicenter PROTECT II Randomized Study). Am J Cardiol, 114(5), 657–664. https://doi.org/10.1016/j.amjcard.2014.05.055
Pershad, Ashish, Ghassan Fraij, Joseph M. Massaro, Shukri W. David, Neal S. Kleiman, Ali E. Denktas, B Hadley Wilson, et al. “Comparison of the use of hemodynamic support in patients ≥80 years versus patients <80 years during high-risk percutaneous coronary interventions (from the Multicenter PROTECT II Randomized Study).Am J Cardiol 114, no. 5 (September 1, 2014): 657–64. https://doi.org/10.1016/j.amjcard.2014.05.055.
Pershad A, Fraij G, Massaro JM, David SW, Kleiman NS, Denktas AE, Wilson BH, Dixon SR, Ohman EM, Douglas PS, Moses JW, O’Neill WW. Comparison of the use of hemodynamic support in patients ≥80 years versus patients <80 years during high-risk percutaneous coronary interventions (from the Multicenter PROTECT II Randomized Study). Am J Cardiol. 2014 Sep 1;114(5):657–664.
Journal cover image

Published In

Am J Cardiol

DOI

EISSN

1879-1913

Publication Date

September 1, 2014

Volume

114

Issue

5

Start / End Page

657 / 664

Location

United States

Related Subject Headings

  • Ventricular Function, Left
  • United States
  • Treatment Outcome
  • Survival Rate
  • Risk Factors
  • Reoperation
  • Prospective Studies
  • Postoperative Complications
  • Percutaneous Coronary Intervention
  • Middle Aged