Selection bias persists in complex and high-risk PCI

September 14, 2022

2 minutes to read

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Data from retrospective analysis show that there are significant differences in complex types High-risk PCI cases conducted across centers in England and Wales, as well as differences in clinical outcomes across age groups.

“The nature of high-risk complex cases performed in elective PCI varies by age, with lower prevalence of cardiac metabolic risk factors among older patients,” Mamas A. Mamas, DPhil, MRCP, a professor of cardiology in the Keele Cardiovascular Research Group at Keele University in Staffordshire, UK, told Helio. “This in my opinion would indicate an element of selection bias, with only lower-risk elderly patients being referred to PCI.”

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In a retrospective study, Mamas and colleagues analyzed national registry data on complex and high-risk PCI in patients with stable angina in England and Wales from 2006 to 2017, divided into three age groups: <65 years; 65 to 79 years and 80 years or older.

Of the 424,290 elective percutaneous interventional procedures, 33% were considered high-risk complex cases. 33.7% of these were performed on adults under 65 years of age; 42.9% were performed on adults aged 65 to 79 years and 23.4% on adults aged at least 80 years.

Among the high-risk complex types, chronic total obstruction (49.2%), previous CABG (30.4%) and severe vascular calcification (21.8%) were common among adults <65 years of age. CABG (42.9%), CTO (32.9%) and severe vascular calcifications (27%) were common among adults aged 65 to 79 years; And previous CABG (15.8%), acute vascular calcification (15.5%) and chronic renal failure (11.1%) were It is common among the eighty-year-olds.

Compared with adults younger than 65, those aged 65-79 were more likely to experience adverse outcomes, including death (adjusted odds ratio = 1.7; 95% confidence interval, 1.3-2.3), major bleeding (aOR = 1.3; 95% CI, 1.1-1.5) and MACCE (aOR = 1.2; 95% CI, 1-1.3). Ocgenic subjects were more than twice as likely to die (aOR = 2.6; 95% CI, 1.9-3.6); and more likely to have major bleeding (aOR = 1.4; 95% CI, 1.1-1.7) and MACCE (aOR = 1.3; 95% CI, 1.1-1.5) compared with younger adults.

“Given that our population is aging, coronary calcification will increasingly become a complex and high-risk factor in the practice of PCI in the future, and the algorithms will need to be further refined when performing such cases in the elderly population, especially now that so many options are available. Calcium modification strategies,” Mamas told Helio. High-risk complex PCI was common among patients of all age groups with significant left ventricular dysfunction. Given the results of the recent REVIVED-BCIS2 study, the role of elective PCI in this group of patients, especially those without symptoms, should be re-evaluated. “

Mamas said there is a need for consensus on what is meant by a “complex” PCI, as there is no uniformly accepted definition.

“We will need to analyze the long-term outcomes of these patients, with a particular focus on antiplatelet selection and duration in these patient groups,” Mamas said.


for more information:

Mamas A. Mamas, DPhil, MRCP can be reached at; Twitter: @mamamas1973.