Coronary atherectomy is used to treat severely calcified coronary artery lesions which are more frequent with increasing age, but its impact in older adults has not been sufficiently examined.

We compared adults ≥ 18 years old who underwent coronary atherectomy during inpatient PCI in 2016–2023 from the Vizient Clinical Data Base and compared outcomes in younger (< 65 years), youngest-old (65–74 years), middle-old (75–84 years), and oldest-old (≥ 85 years) adults. Primary outcome was in-hospital mortality, and secondary outcomes included postprocedural complications.

Among 47,337 patients who underwent coronary atherectomy, 19,862 (42.0%) were younger adults and 27,475 (58.0%) were older adults, including 13,583 youngest-old, 10,206 middle-old, and 3,686 oldest-old adults. Compared with younger adults, youngest-old adults had higher mortality (adjusted odds ratio [aOR] = 1.37, P < 0.001), ischemic stroke (aOR = 1.35, P = 0.005), gastrointestinal hemorrhage (GIH) (aOR = 1.44, P < 0.001), acute kidney injury (AKI) (aOR = 1.43, P < 0.001), tamponade (aOR = 1.86, P < 0.001), and pericardiocentesis (aOR = 2.32, P < 0.001). Middle-old adults had higher mortality (aOR = 1.80, P < 0.001), GIH (aOR = 1.42, P = 0.002), AKI (aOR = 1.63, P < 0.001), tamponade (aOR = 2.52, P < 0.001), and pericardiocentesis (aOR = 3.13, P < 0.001). Oldest-old adults had the highest odds for mortality (aOR = 2.03, P < 0.001), GIH (aOR = 1.48, P = 0.016), AKI (aOR = 2.26, P < 0.001), tamponade (aOR = 3.86, P < 0.001), and pericardiocentesis (aOR = 4.21, P < 0.001). There was a significant interaction (P-interaction=0.035) between atherectomy and age groups with regard to the odds of in-hospital mortality.

In this large claims-based study, in-hospital mortality, GIH, AKI, tamponade, and pericardiocentesis were higher in older adults compared with younger adults, in a stepwise manner by age group.

Percutaneous coronary intervention (PCI) for stable ischemic heart disease (SIHD) in older adults requires a meticulous assessment of procedural risks and benefits, but contemporary data on outcomes in this population is lacking. Therefore, we examined the risk of near-term readmission, bleeding, and mortality in high-risk cohort of older adults undergoing inpatient PCI for SIHD.

We analyzed the National Readmissions Database from 2017 to 2018 to identify index hospitalizations in which PCI was performed for SIHD. Patients were stratified into those ≥ 75 years old (older adults) and those < 75 years old. The primary outcome was 90-day readmission. Secondary outcomes included in-hospital mortality, hospital length of stay (LOS), and total hospital charge.

A total of 74,516 patients underwent inpatient PCI for SIHD, of whom 24,075 were older adults. Older adult patients had higher odds of in-hospital mortality (OR = 2.00, 95% CI: 1.68-2.38), intracranial hemorrhage (OR = 2.03, 95% CI: 1.24-3.34), and gastrointestinal hemorrhage (OR = 1.72, 95% CI: 1.43-2.07) during index hospitalization, with longer LOS and in-hospital charge. Older adults also experienced a higher hazard of 90-day readmission for any cause (HR = 1.61, 95% CI: 1.57-1.66) and cardiovascular causes (HR = 1.84, 95% CI: 1.77-1.91).

Older adults undergoing inpatient PCI for SIHD were at increased risk for in-hospital mortality, periprocedural morbidities, higher cost, and readmissions compared with younger adults. Understanding these differences may improve shared decision-making for patients with SIHD being considered for PCI.