Nationwide Trends in PCI Outcomes for Older Acute Coronary Syndrome Patients with a History of CABG.

BACKGROUND

Techniques for percutaneous coronary intervention (PCI) have evolved over the last decade. However, there is not enough data on recent trends among high-risk groups, particularly patients with a Coronary Artery Bypass Graft (CABG). This study examines current PCI outcomes in older patients with Acute Coronary Syndrome (ACS) and a history of CABG. It aims to provide useful insights for this vulnerable group.

METHODS

We analyzed the 2016-2020 National Inpatient Sample database along with the relevant ICD-10-CM codes. The focus was on PCI outcomes for ACS patients aged 65 and older who have a history of CABG. We measured primary outcomes to evaluate observed trends.

RESULTS

Out of 94,610 patients, 74.5% were male, and 84.1% were white, with a median age of 75 years. A significant 94.6% underwent non-elective PCI. Common additional health issues included hyperlipidemia (83.7%), smoking (40%), complicated diabetes (34.6%), and hypertension (53.7%). We found statistically significant differences in post-catheterization-related bleeding, post-procedural respiratory failure, and Impella usage after PCI (all P<0.001). There were declining trends in PC-B (1.5% in 2016 vs. 0.7% in 2020, P<0.001) and PP-RF (0.3% in 2016 vs. 0.2% in 2020, P<0.001), with an increase in Impella usage post-PCI (1.2% in 2016 vs. 2.1% in 2020). There were declining trends in postcatheterization bleeding (1.5% [95% CI: 1.2-1.8] in 2016 vs. 0.7% [95% CI: 0.5-0.9] in 2020, P<0.001) and post-procedural respiratory failure (0.3% [95% CI: 0.2-0.4] vs. 0.2% [95% CI: 0.1-0.3], P<0.001), with an increase in Impella use (1.2% [95% CI: 1.0-1.5] vs. 2.1% [95% CI: 1.8-2.4], P<0.001). Following PCI, there were no statistically significant differences in outcomes such as All-Cause Mortality (ACM), Intracranial Bleed (IC-B), Cardiac arrest (CA), Postprocedural Stroke (PP-S), Cardiogenic Shock (CS), and intra-aortic balloon pump (IABP) and Intra-Aortic Balloon Pump (IABP) usage.

DISCUSSION: Our study showed improved bleeding outcomes and postprocedural respiratory failure. We also noticed a rising trend in Impella use among older CABG patients with ACS. This trend reflects advances in coronary intervention technology and improved access techniques. However, there were no statistical differences in ACM, IC-B, CA, PP-S, CS, and IABP use. This underscores the complexity of the anatomy, the challenges of the procedure, and the high-risk nature of the population. It calls for a tailored approach to these patients to achieve better outcomes.