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[Long-term results of coronary balloon angioplasty in various age groups]
T Przewłocki1, P Pieniazek, W Tracz
1Klinika Chorób Serca i Naczyń, Instytutu Kardiologii, Collegium Medicum, Uniwersytetu Jagielońskiego w Krakowie.
Insights
Balloon angioplasty shows similar short-term results across all age groups. However, older patients (over 50) face higher restenosis and reintervention rates, while younger patients have more myocardial infarctions.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Outcomes
Context:
- Coronary artery disease (CAD) management varies by patient age.
- Younger patients with CAD may have a more dynamic disease course.
- Long-term outcomes of revascularization in different age groups require detailed analysis.
Purpose:
- To compare early and long-term outcomes of balloon angioplasty in patients stratified by age.
- To identify age-related differences in clinical factors, procedural results, and follow-up events.
- To evaluate the impact of age on restenosis, reintervention, and major adverse cardiac events.
Summary:
- A study of 630 patients undergoing balloon angioplasty revealed similar immediate success rates and complication rates across four age groups (<40, 41-50, 51-60, >60).
- Over a 5-year follow-up, restenosis and reintervention rates significantly increased with patient age, particularly for those over 50.
- Younger patients (<40) experienced more myocardial infarctions, while older patients (>50) had a higher incidence of major coronary events and poorer functional status.
- Survival rates were high and comparable across all groups, but age over 50 emerged as an independent predictor for restenosis, reintervention, and major coronary events.
Impact:
- Age is a significant factor influencing the long-term efficacy and safety of balloon angioplasty for coronary artery disease.
- Findings suggest tailored follow-up strategies may be beneficial for different age demographics undergoing revascularization.
- Identifies specific age-related risks, such as restenosis in older patients and myocardial infarction in younger ones, guiding clinical decision-making.
Unlabelled:
Some data indicate that natural history of coronary artery disease in younger patients is characterised by high dynamics and therefore the long-term results of revascularisation procedures have generally poorer outcome. To verify this we compared the early and the long-term results of balloon angioplasty in 630 consecutive patients divided into four age groups: < 40 years (77 patients), 41-50 years (247 patients), 51-60 years (160 patients) and > 60 years (146 patients). Groups differed significantly in many clinical factors: higher proportion of women and unstable angina were encountered in older groups, while higher frequency of hypertension, hypertriglycerydaemia, current smoking, familial history of angina, prior myocardial infarction, were more often observed in younger patients. Groups did not differ in such angiographic factors as: global ejection fraction (EF), presence of multivessel disease, type of dilated lesions and vessels, multilesion PTCA, except higher frequency of EF < 50% in patients < 40 years of age. Immediate results of angioplasty did not differ significantly between the respective age groups: success rate was 87-94%, complications rate between 4.5% and 6.5%, complete revascularisation was achieved in 46-61% patients (NS). In the mean 5-year follow-up period repeated angiography was carried out with comparable frequency in about half of the studied patients (NS). Restenosis rate equalled 21-42% and significantly increased with the patients' age (p = 0.02 in chi 2, 0.009 in log-rank test), the related reinterventions rate likewise (p = 0.05 in chi 2, 0.009 in log-rank test). We did not observe any differences among the respective groups with regard to significant atherosclerosis progression, which was encountered in 15-19% of patients (NS). Survival rate did not differ significantly either, being in fact quite high (96-99%). Myocardial infarction in follow-up significantly more frequently (p = 0.01) occurred in patients < 40 years of age, in comparison with patients > 60 years of age, although it did not differ significantly in terms of overall test for independence (p = 0.3) and log-rank test (p = 0.07). The frequency of major coronary events significantly increased according to patients' age as opposed to the event-free survival (p = 0.02 in both tests). Uni and multivariate analysis confirmed that age over 50 years is an independent factor of restenosis, reintervention, and major coronary event in follow-up. Patients functional status at the end of observation period, according to CCS criteria, proved that in the older age groups the percentage of patients with none, or minor anginal complaints decreased, whereas the proportion of patients exhibiting the symptoms of severe angina (Class III and IV) significantly increased (p = 0.006).
Conclusions:
Balloon angioplasty offered similar short-term outcome in all age groups, as well as the survival rate during the 5-year follow-up period. Frequency of restenosis significantly increased in older patients especially the ones over 50 years of age; this in turn resulting in a higher reinterventions rate among them. On the other hand, patients below 40 years of age suffered more frequently from myocardial infarction during the follow-up period. Major coronary events were more frequent in patients over 50 years of age. Better functional status was observed in younger patients at the end of observation period.