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Transluminal coronary balloon angioplasty: a useful therapeutic modality in octogenarian patients with severe angina
J J Glazier1, M C Vrolix, F Stammen
1Department of Cardiology and Cardiovascular Surgery, University Hospital Gasthuisberg, Leuven, Belgium.
Insights
Percutaneous transluminal coronary angioplasty (PTCA) offers positive outcomes for octogenarian patients with severe angina. This study shows 89% success and sustained symptom relief in elderly individuals, suggesting PTCA as a viable treatment option.
Area of Science:
- Cardiology
- Interventional Cardiology
- Geriatric Medicine
Background:
- Severe angina significantly impacts quality of life, especially in elderly patients.
- Optimal medical therapy is often insufficient for managing advanced coronary artery disease in octogenarians.
- Multivessel coronary artery disease is common in this patient demographic.
Purpose of the Study:
- To report the immediate and short-term outcomes of percutaneous transluminal coronary angioplasty (PTCA) in patients aged 80 years and older.
- To evaluate the safety and efficacy of PTCA in a cohort of elderly patients with severe, refractory angina.
- To assess the long-term clinical status and need for reintervention after PTCA in octogenarian patients.
Main Methods:
- A consecutive series of 9 patients aged 80+ underwent PTCA for severe angina.
- Primary success was defined as successful dilation without immediate complications.
- Follow-up data were collected to assess clinical outcomes, including mortality, revascularization, and symptom recurrence.
Main Results:
- Primary PTCA success was achieved in 89% (8 of 9) of patients.
- The single patient with PTCA failure underwent successful coronary artery bypass graft surgery.
- Over a mean follow-up of 27 months, no deaths, myocardial infarctions, or repeat revascularization procedures occurred in the 8 patients with primary PTCA success.
- 75% of patients remained asymptomatic, with one experiencing mild, non-restrictive angina recurrence.
Conclusions:
- Percutaneous transluminal coronary angioplasty demonstrates favorable immediate and short-term outcomes in selected octogenarian patients with severe angina.
- PTCA offers a safe and effective revascularization strategy, leading to sustained symptom relief and improved quality of life in this elderly population.
- These findings support considering PTCA as a valuable treatment option for octogenarians with severe angina unresponsive to medical management.
Abstract:
In this study, the immediate and short-term outcome of 9 consecutive patients aged 80 years or older undergoing percutaneous transluminal coronary angioplasty (PTCA) are reported. Of these 9 patients, 8, despite optimal medical therapy, had unstable Class IV anginal symptoms and 6 had multivessel coronary artery disease. Primary success at PTCA (successful dilation of all attempted lesions without any complications) was achieved in 8 of the 9 (89%) patients. The one patient with unsuccessful PTCA had subsequent successful elective coronary bypass graft surgery. The 8 patients with primary success at PTCA have been followed up for a mean of 27 +/- 15 (range: 6 to 45) months. During follow-up, no patient died, required a further revascularization procedure or had a myocardial infarction. Indeed, 7 of these 8 patients have, following PTCA, remained entirely asymptomatic with no decrease in their activity level. Angina has recurred in 1 patient but it is mild and does not restrict his activities. Based on our encouraging experience we suggest that PTCA should be considered favourably in the treatment of selected octogenarian patients with severe angina poorly controlled by medical therapy.