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Elderly and younger patients selected to undergo coronary angiography
A T Elder1, T R Shaw, C M Turnbull
1Department of Geriatric Medicine, City Hospital, Edinburgh.
Insights
Older patients undergoing coronary angiography present with more severe chest pain and advanced coronary artery disease. Despite higher operative risks, they experience similar symptomatic benefits from surgery as younger patients.
Area of Science:
- Cardiology
- Geriatric Medicine
- Interventional Cardiology
Background:
- Chest pain is a common symptom necessitating investigation.
- Coronary angiography is a key diagnostic tool for coronary artery disease.
- Understanding differences in older versus younger patients is crucial for effective management.
Purpose of the Study:
- Compare characteristics of older (≥70 years) and younger patients with chest pain undergoing coronary angiography.
- Assess the diagnostic and therapeutic value of coronary angiography in elderly patients.
Main Methods:
- Retrospective analysis of clinical case notes and coronary angiography reports.
- Inclusion of 134 older patients (≥70 years) and 134 younger patients with chest pain.
- Comparison of clinical and angiographic features, and post-angiography management.
Main Results:
- Older patients had longer symptom duration, more severe symptoms, and higher rates of triple vessel disease, left main stem stenosis, and left ventricular impairment.
- Similar proportions of older and younger patients underwent coronary artery surgery, with elderly patients more frequently requiring urgent procedures.
- Operative mortality was higher in older patients, but symptomatic benefit was comparable to younger patients.
Conclusions:
- Elderly patients selected for coronary angiography and surgery exhibit more severe cardiac disease.
- Earlier investigation may reduce operative risks in older adults.
- Patient selection for coronary angiography and surgery should prioritize potential benefit over age, avoiding ageism.
Objective:
To establish and compare the characteristics of older (greater than or equal to 70 years) and younger patients with chest pain selected to undergo coronary angiography and by analysis of their subsequent management to assess the value of coronary angiography for older patients with chest pain.
Design:
Retrospective analysis of clinical case notes and coronary angiography reports.
Setting:
Cardiology department with referral population of one million in an Edinburgh hospital.
Patients:
134 consecutive patients with chest pain aged 70 years or over investigated by coronary angiography between 1978 and 1988; 134 randomly selected patients aged under 70 investigated over the same period.
Main Outcome Measures:
Clinical and angiographic features at time of angiography and management after angiography.
Results:
Older patients represented a small, but increasing, proportion of those investigated. Older patients had more severe symptoms at the time of angiography, were taking more antianginal drugs, and had had their symptoms for longer than younger patients. At angiography more older patients had triple vessel coronary disease, left main stem stenosis, or left ventricular impairment. After angiography similar proportions of older and younger patients underwent coronary artery surgery, with more elderly patients requiring urgent operation; although operative mortality was higher for elderly patients, symptomatic benefit was similar to that in younger patients.
Conclusions:
Older patients with angina selected to undergo coronary angiography and subsequent coronary surgery have more severe symptoms and underlying cardiac disease. Earlier referral and investigation might yield a population with lower operative risk. Selection of patients for coronary angiography and coronary artery surgery should be based on the potential for benefit and should avoid "agism."
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