Prognosis of PCI in the Older Adult Population: Outcomes From the Multicenter Prospective E-ULTIMASTER Registry

Background: Older adult patients undergoing percutaneous coronary intervention (PCI) are usually excluded from clinical trials. This study aimed to assess 1-year clinical outcomes in patients aged >80 years.

Methods: This all-comer registry included patients who underwent PCI using the Ultimaster stent. Primary clinical endpoint was target lesion failure (TLF), a composite of cardiac death (CD), target vessel-related myocardial infarction (TV-MI), or clinically indicated target lesion revascularization (CD-TLR).

Results: In total, 3286 (8.8%) patients aged ≥80 years were compared with 33,912 patients aged <80 years. The older adult patients included more women, had more comorbidities and exhibited more complex coronary anatomy. The incidence of TLF was higher in the older adult group (5.6% vs 3.0%, < .0001), as well as for all-cause mortality (6.2% vs 1.7%, < .0001), CD (3.3% vs 1.1%, < .0001), and TV-MI (1.7% vs 0.8%, < .0001), but not for CD-TLR (1.9% vs 1.7%, = .15). After the inverse propensity score weighted analysis, aged ≥80 years was associated with increased risk of TLF (HR, 1.42; 95% CI, 1.22-1.66; < .0001), CD (HR, 1.67; 95% CI, 1.136-2.06; < .0001), and TV-MI (HR, 1.66; 95% CI, 1.24-2.24; < .001) but not for CD-TLR (HR, 1.10; 95% CI, 0.85-1.43; = .45).

Conclusion: Older adult patients had a higher incidence of TLF, CD, and TV-MI but with no difference in the incidence of recurrent revascularization or stent thrombosis. Although PCI in older adults is relatively safe, higher rates of cardiac events should be considered.