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Cited by 18Coronary Interventions and DiagnosticsCardiac Imaging and DiagnosticsCardiovascular Syncope and Autonomic Disorders

Percutaneous coronary intervention for older adults who present with syncope and coronary artery disease? Insights from the National Cardiovascular Data Registry

Anderson, Lindsay L., Dai, David, Miller, Amy Leigh, Roe, Matthew T., Messenger, John C., Wang, Tracy Y.·2016·American Heart Journal
DOI 10.1016/j.ahj.2016.02.017
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Abstract

Background We explored the risks/benefits of revascularization versus medical management in syncope patients with obstructive coronary artery disease (CAD).Methods We retrospectively examined Medicare patients ≥65 years undergoing percutaneous coronary intervention (PCI) for syncope at 539 CathPCI Registry hospitals with ≥70% stenosis in at least 1 coronary artery, excluding those with ST-segment elevation myocardial infarction (MI), cardiogenic shock, left main disease, and coronary artery bypass grafting. In a propensity-matched population, we compared short-term (90-day) all-cause readmission risk and long-term (3-year) risks of readmission for syncope and MI, as well as mortality in those receiving PCI versus medical management.Results Among 14,674 syncope patients, 9,549 (65%) had at least 1-vessel obstructive CAD. After exclusions, 3,196 of 7,338 patients (44%) underwent PCI. In the propensity-matched cohort, there was no significant difference in 90-day all-cause readmission risk (28.2% vs 30.3%, adjusted hazard ratio [HR] 0.92, 95% CI 0.83-1.02) or long-term risks of readmission for syncope (7.0% vs 6.1%, adjusted HR 1.06, 95% CI 0.83-1.35). PCI-treated patients had significantly higher risk of readmission for MI (5.6% vs 4.0%, adjusted HR 1.56, 95% CI 1.18-2.06) but lower risk of long-term mortality (27.0% vs 30.3%, adjusted HR 0.86, 95% CI 0.77-0.97) than medically managed patients.Conclusions In patients presenting with syncope and obstructive CAD, PCI was not associated with significant improvements in the risk of readmission but was associated with lower long-term mortality compared with medical therapy, suggesting the need to more definitively assess the benefit of PCI among elderly syncope patients.

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Crossref · 10.1016/j.ahj.2016.02.017

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  • In patients presenting with syncope and obstructive coronary artery disease, percutaneous coronary intervention is not associated with a significant reduction in readmission for syncope.

    “In patients presenting with syncope and obstructive coronary artery disease, percutaneous coronary intervention is not associated with a significant reduction in readmission for syncope. 258”

    From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [258]

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Authors
Anderson, L. L., Dai, D., Miller, A. L., Roe, M. T., Messenger, J. C., & Wang, T. Y.
Affiliations
  • Duke Medical Center (US)
  • Brigham and Women's Hospital (US)
  • University of Colorado Denver (US)
Corresponding author
Wang, Tracy Y.
ORCID
Venue
American Heart Journal
Publisher
Elsevier BV
Published
2016-06
Volume
176
Pages
1-9
ISSN
0002-8703 (ISSN-L)
DOI
10.1016/j.ahj.2016.02.017
OpenAlex
W2283903066
Cited by
18
References
21
Citations by year
2026: 1 · 2025: 1 · 2023: 2 · 2022: 2 · 2021: 3 · 2020: 1 · 2019: 1 · 2018: 6 · 2017: 1
FWCI
2.95
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • American Heart Journal (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Coronary Interventions and Diagnostics
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
  • Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
Keywords
percutaneous coronary intervention, syncope, coronary artery disease, older adults, hospital readmission, myocardial infarction, long-term mortality, Medicare beneficiaries, CathPCI Registry
MeSH terms
Aged, Cardiovascular Agents, Coronary Artery Disease, Coronary Vessels, Female, Humans, Male, Outcome and Process Assessment, Health Care, Patient Readmission, Retrospective Studies, Syncope, United States, Coronary Angiography, Risk Assessment, Propensity Score, Percutaneous Coronary Intervention

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