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Coronary angioplasty in octogenarians: comparisons to coronary bypass surgery
R K Myler1, J G Webb, K P Nguyen
1San Francisco Heart Institute, Seton Medical Center, Daly City, CA 94015.
Insights
Coronary angioplasty is a viable treatment for elderly patients (80+) with coronary artery disease, showing high success rates and good long-term survival. This procedure offers a favorable alternative to bypass surgery in this population.
Area of Science:
- Cardiology
- Interventional Cardiology
- Geriatric Medicine
Background:
- Elderly patients (80 years and older) often present with complex coronary artery disease.
- Treatment options for this demographic require careful consideration of risks and benefits.
Purpose of the Study:
- To evaluate the safety and efficacy of coronary angioplasty in patients aged 80 and older.
- To assess the long-term outcomes, including mortality and reintervention rates, following angioplasty in this elderly cohort.
Main Methods:
- Retrospective analysis of 74 patients aged 80 and older undergoing coronary angioplasty.
- Detailed recording of procedural success, complications, and long-term follow-up data (mean 24 months).
- Life-table analysis used to determine actuarial survival and freedom from adverse events.
Main Results:
- Successful angioplasty was achieved in 80% of patients.
- The overall hospital mortality rate was low at 1.4%, with one emergency bypass surgery required due to abrupt closure.
- Long-term survival was 90%, with 86% survival free from myocardial infarction or bypass surgery at 3 years.
Conclusions:
- Coronary angioplasty is a safe and effective revascularization strategy for selected elderly patients (80+).
- The procedure demonstrates favorable long-term survival and event-free survival rates in this population.
- Angioplasty offers a valuable alternative to coronary artery bypass grafting in octogenarians.
Abstract:
Coronary angioplasty was performed in 74 patients 80 years of age and older (mean 83 +/- 3). Single vessel coronary disease was present in 34% and multivessel coronary disease in 66%. Angioplasty of a single vessel was performed in 51 patients (69%), while 23 (31%) had angioplasty of multiple vessels. Angioplasty was successful in 59 of 74 patients (80%). Angioplasty was unsuccessful but uncomplicated in 12 (16%) due to (unyielding) calcified lesions or (impassable) old occlusions. Of these 12, 8 were discharged on medical therapy and 4 underwent elective uncomplicated bypass surgery prior to discharge. Three (4%) patients required emergency coronary bypass surgery due to abrupt vessel closure during the angioplasty procedure, with one hospital death (1.4%). Follow-up (mean 24 +/- 22 months) was obtained in all patients. Of the 59 successful angioplasty patients, late mortality was 10% (cardiac 7% and non-cardiac 3%). Survival and survival without myocardial infarction were both 90%; survival without either infarction or bypass surgery was 86%. Actuarial 3-year survival was 91% and 3-year freedom from death, infarction or bypass surgery was 87% by life-table analysis. Repeat angioplasty for restenosis was performed in 7 patients (12%) without complications.