Detection of Progression of Coronary Artery Disease in the Elderly

In order to assess the progression of coronary artery disease (CAD) in the elderly, we evaluated 91 patients aged 75 years or older who had undergone 2 consecutive angiograms without intervening revascularization. Progression was defined as an absolute increase in lumen narrowing by at least 20% with minimum stenosis of 50% at second angiogram, or progression to total occlusion of any preexisting lesion. Progression involving at least 1 vessel was observed in 63% of patients. Only 6% of initially normal or insignificantly diseased segments showed progression. In contrast, 72% of segments that progressed to total occlusion had shown an initial narrowing greater than 75%. Progression occurred in 100% of patients with an interval myocardial infarction, but in no patients with symptomatic valvular disease. No regression was observed, while 7 of 36 (19%) of initially occluded segments had recanalized. We conclude that progression of CAD in the elderly occurs at rates similar to those observed in a younger population; however no correlation could be found between the rate of progression and either risk factors or elapsed time between angiographic studies.