Abstract 4367639: Interaction of Age, Peripheral Artery Disease, and In-hospital Outcomes Among Patients Undergoing Index Percutaneous Interventions

Abstract

Introduction: Peripheral artery disease (PAD) is known risk factor for adverse cardiovascular outcomes as well as coronary artery disease. However, the interaction between PAD and advanced age on outcomes after percutaneous coronary intervention (PCI) remains understudied and may aid in risk stratification. We aimed to assess the association of PAD with in-hospital mortality and length of stay (LOS) in patients undergoing PCI, and to evaluate the interaction between PAD and age in each model. Methods: We included patients ≥18 years old from the Vizient® Clinical Data Base from 2016–2023 undergoing an index PCI. PAD was defined using ICD-10 codes. Age ≥80 years was used to define the older age stratum for interaction analysis. Multivariable logistic regression analysis and Poisson regression models were used to assess the association between PAD and in-hospital mortality and LOS, respectively, adjusting for demographics, hospital characteristics, and clinical comorbidities. Predicted LOS and mortality risk were calculated as well as interaction terms between PAD and age ≥80 for each model. Results: We included 287,150 patients (mean age 79.8 years ± 14.8; female 31.7%, 13.8% had PAD). PAD was significantly associated with in-hospital mortality (OR=1.25; 95% CI 1.15–1.35; p<0.001). The interaction between PAD and age ≥80 for in-hospital mortality was significant (p=0.001). Compared with patients <80 years old without PAD, in-hospital mortality was increasingly associated among patients ≥80 years old without PAD (OR 1.65; 95% CI 1.60–1.71; p<0.001), higher among patients <80 years old with PAD (OR 1.50; 95% CI 1.31–1.72; p<0.001), and strongest among patients ≥80 years old with PAD (OR 1.77; 95% CI 1.61–1.95; p<0.001). PAD was also associated with a significantly longer LOS (IRR = 1.13; 95% CI 1.12–1.14; p<0.001), with a significant interaction with age (p=0.001). Compared with patients <80 without PAD, LOS was higher in those age ≥80 without PAD (IRR = 1.088; 95% CI 1.084–1.092), and significantly higher in those with PAD across the age spectrum (<80: IRR = 1.192; 95% CI 1.175–1.210; p<0.001; ≥80: IRR = 1.194; 95% CI 1.182–1.208; p<0.001). Conclusion: PAD is associated with a prolonged LOS and higher in-hospital mortality in those undergoing PCI. There is a significant interaction between PAD and age ≥80 years for both LOS and in-hospital mortality, suggesting older adults are a vulnerable sub-group for prolonged care and fatality following a PCI trajectory.