Abstract 39: Clinical Outcomes Of Octogenerians Requiring Urgent Cardiac Catheterization: Percutaneous Intervention versus Medical Therapy.

INTRODUCTION: Octogenarians comprise an increasing proportion of patients undergoing coronary angiography and percutaneous coronary interventional (PCI). Most interventional studies have focused on patients aged 50-65 years and as such there is paucity of scientific evidence regarding interventions in octogenarians. While there have been some improvements in intervention techniques with more octogenarians undergoing PCI safely, many physicians are still reluctant to recommend invasive treatment for this group. We sought to compare the clinical outcomes in the treatment options (PCI vs medical therapy) among octogenarians requiring urgent cardiac catheterization (CC). METHODS: This was a single center retrospective study of 1184 consecutive patients requiring urgent CC. Urgent CC was defined as catheterization within 24 hours of the admission symptom onset. Patients were categorized according to either PCI group (PCIG) versus medical treatment group (MTG) after coronary angiography. Patients were then followed for cardiovascular and all cause mortality as well as cardiovascular and all cause readmissions at 30 days and 1 year from the index event. RESULTS: There were 1184 patients that met inclusion criteria. Thirty five percent (416) underwent PCI and 65% (768) had medical treatment. Mean age was 84+/-3 for PCIG versus 83 +/- 3 for the medical group. (p=NS), 53% (220) of PCIG were male versus 51% (391) MTG (p =NS), 86% (358) of PCIG had HTN versus 87% (668) MTG. Hyperlipidemia was present in 79% (328) of PCIG vs 77% (591) of MTG. Ninety seven percent(403) of the PCIG presented with chest pain versus 94%(722) in the MTG (p=NS) Length of stay for both groups was 3+/-2 days (p=NS). Thirty-day mortality for PCIG was 3% (12) vs. 2 % (23) in the MTG (p=NS). One year mortality in the PCIG was 5 % (21) vs. 3% (23) in the MTG (p=NS) Thirty day all cause readmission for the PCIG was 8% (33) vs. 9% (69) in the MTG (p=NS) .One year all cause readmission for the PCIG was 18% (75) vs. 16% (122) for the MTG (p=NS). Thirty day cardiovascular readmission for the PCIG was 8% (33) vs. 10%(77) (p=NS) in the MTG. One year cardiovascular readmission for PCIG was 18% (75) vs. 21% (161) in the MTG (p=NS). Readmissions at one year for revascularization for both (PCI and coronary artery bypass graft surgery) was 13% (54) in the PCIG vs. 12%(92) in the MTG (p=NS). CONCLUSION: Percutanous intervention in octogenarians presenting for urgent cardiac catherterization had similar short and intermediate term outcomes when compared to those undergoing medical management.