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[Coronary angiography in patients over 80 years of age: indications, results, consequences]
A Kirchgatterer1, T Weber, J Auer
1II. Internen Abteilung mit Kardiologie des A. ö. Krankenhauses der Barmherzigen Schwestern vom Hl. Kreuz, Wels.
Insights
Coronary angiography in patients aged 80+ is valuable, often revealing multi-vessel coronary artery disease and unstable angina, guiding necessary interventions like percutaneous coronary intervention or surgery.
Area of Science:
- Cardiology
- Geriatric Medicine
- Interventional Cardiology
Background:
- The aging population increases the prevalence of cardiovascular disease in elderly patients.
- Coronary angiography in octogenarians requires careful benefit-risk assessment due to procedural costs and invasiveness.
Purpose of the Study:
- To investigate the indications and frequency of coronary angiography in patients aged 80 years and older.
- To evaluate the diagnostic yield, procedural risks, and therapeutic outcomes of coronary angiography in this demographic.
Main Methods:
- Retrospective analysis of 66 coronary angiographies performed on 61 patients aged 80 years or older.
- Review of patient demographics, clinical presentation, angiographic findings, and subsequent treatment decisions.
Main Results:
- 55% of elderly patients undergoing coronary angiography had multi-vessel coronary artery disease.
- Unstable angina was the predominant clinical presentation (82%) in patients referred for suspected coronary artery disease.
- Revascularization procedures, including percutaneous coronary intervention and bypass surgery, were feasible in 43% of patients with multi-vessel disease.
Conclusions:
- Coronary angiography is a crucial diagnostic tool in elderly patients, particularly those presenting with unstable angina.
- The findings often necessitate intervention, with a significant proportion of multi-vessel disease patients amenable to revascularization.
- Careful consideration of the benefits and risks is warranted, but the procedure provides valuable information for managing cardiovascular disease in the elderly.
Abstract:
Due to the continuous increase of elderly individuals in the society the cardiologist has to deal with elderly patients more often. The apparative expenditures and the invasive procedure require a critical consideration of benefits and risks prior to performing coronary angiography in these patients. The indication and frequency of coronary angiography in patients with eighty years or above were investigated. Furthermore, the results of angiography, the risks of the procedure and the therapeutic consequences were evaluated. The whole study population consisted of 2,500 consecutive patients (1,557 men, 943 women), who underwent coronary angiography at our institution from January 1st to November 16th in 1998. A retrospective analysis of 66 coronary angiographies (3%) in 61 patients (26 men, 35 women) aged 80 years or older was performed. Among these 61 patients, 51 were referred because of suspected coronary artery disease. Due to the clinical presentation a high percentage (42 patients = 82%) was classified as having unstable angina. 10 patients were referred due to valvular heart disease. Single-vessel disease was found in 14, two-vessel disease in 5 and multi-vessel disease in 28 patients, respectively. Percutaneous coronary intervention was performed in 17 patients, among these were 9 patients with multi-vessel disease and PTCA of the culprit lesion, and 3 patients underwent bypass surgery. Medical therapy was decided as to 28 patients. Aortic valve replacement was performed in 2 of 9 patients with aortic stenosis. The clinical appearance of coronary artery disease in elderly patients was mostly unstable angina, explaining the need for intervention. Coronary angiography disclosed multi-vessel disease in 55% of patients. A revascularization procedure could be performed at least in 43% of patients with multi-vessel disease.