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Early and late results of coronary angioplasty and bypass in octogenarians
M J Mick1, C Simpfendorfer, A Z Arnold
1Department of Cardiology, Cleveland Clinic Foundation, Ohio.
Insights
Octogenarians undergoing coronary revascularization with percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass grafting (CABG) experienced low mortality and good long-term survival. Advanced age should not preclude treatment for severe coronary artery disease.
Area of Science:
- Cardiology
- Geriatric Medicine
- Interventional Cardiology
Background:
- Octogenarians represent a growing population with significant cardiovascular disease burden.
- Revascularization strategies in this age group require careful consideration due to potential risks.
Purpose of the Study:
- To evaluate the early and late outcomes of first-time revascularization in octogenarians.
- To compare outcomes between percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass grafting (CABG) in this population.
Main Methods:
- Retrospective analysis of 195 octogenarians (142 CABG, 53 PTCA) undergoing initial revascularization.
- Comparison of baseline characteristics, procedural complications, hospital mortality, and 3-year survival rates.
Main Results:
- Patients undergoing CABG had more severe disease (3-vessel and left main trunk) and lower left ventricular function compared to PTCA.
- Procedural complications (myocardial infarction, stroke) and hospital mortality were low and similar between groups.
- Three-year survival, excluding hospital mortality, was high and comparable for both CABG (87%) and PTCA (81%) groups.
Conclusions:
- Octogenarians can undergo revascularization with acceptable morbidity and mortality.
- Excellent long-term survival supports considering revascularization for very elderly patients with severe coronary artery disease.
Abstract:
Early and late results were evaluated for octogenarians undergoing first time revascularization with percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass grafting (CABG). The study group consisted of 142 patients with CABG and 53 with PTCA. The groups with PTCA and CABG differed with respect to number of patients with angina class III to IV (92 and 67%, respectively; p less than 0.001), number with 3-vessel disease (34 and 77%, respectively; p less than 0.001), presence of left main trunk disease (2 and 24%, respectively; p less than 0.001) and number with normal or mildly impaired left ventricular function (82 and 65%, respectively; p less than 0.034). The groups with PTCA and CABG had similar procedural complications, including myocardial infarction (6 and 4%, respectively) and stroke (0 and 4%, respectively). Hospital mortality was low (6% with CABG and 2% with PTCA). Three year survival, excluding hospital mortality, was 87% in patients with CABG and 81% in those with PTCA (p = 0.493). Octogenarians underwent revascularization procedures with relatively low morbidity and mortality. In regard to the excellent long-term survival, "very" elderly patients with severe coronary artery disease should be considered for revascularization despite advanced age.
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