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Coronary artery disease in the octogenarian: angiographic spectrum and suitability for revascularization
G J Kowalchuk1, S C Siu, S M Lewis
1New England Deaconess Hospital, Department of Medicine, Boston, Massachusetts 02215.
Insights
Coronary artery disease (CAD) in octogenarians often shows anatomy suitable for bypass surgery (CABG) but less so for angioplasty (PTCA). Both procedures carry high risks in this elderly population.
Area of Science:
- Cardiology
- Geriatric Medicine
- Interventional Cardiology
Background:
- Coronary artery disease (CAD) is a significant health concern in the elderly population.
- Octogenarians present unique challenges for managing CAD due to comorbidities and physiological changes.
Purpose of the Study:
- To evaluate angiographic findings in octogenarians with symptomatic CAD.
- To assess the suitability of coronary anatomy for coronary artery bypass grafting (CABG) and percutaneous transluminal coronary angioplasty (PTCA).
- To determine the outcomes of CABG and PTCA in this patient group.
Main Methods:
- Retrospective analysis of angiographic data from 84 consecutive octogenarians with symptomatic CAD.
- Assessment of coronary anatomy for suitability for CABG and PTCA.
- Review of operative outcomes, including mortality and complication rates for both procedures.
Main Results:
- High prevalence of multi-vessel and left main CAD (57% and 13%, respectively).
- 88% of patients with significant CAD had anatomy suitable for CABG, while only 31% were suitable for PTCA.
- CABG in 19 patients had 16% operative mortality and 37% major complication rate.
- PTCA in 12 patients had 8% mortality and 8% major complication rate with 83% clinical success.
Conclusions:
- Cardiac catheterization frequently reveals coronary anatomy amenable to CABG in octogenarians with CAD.
- Coronary anatomy is less frequently suitable for PTCA in this demographic.
- Interventional procedures for CAD in octogenarians are associated with substantial morbidity and mortality.
Abstract:
The angiographic findings of 84 consecutive octogenarians presenting with symptoms of coronary artery disease (CAD) were examined to determine the extent of CAD as well as suitability for both coronary artery bypass grafting (CABG) and percutaneous transluminal coronary angioplasty (PTCA). The frequency of 0-, 1-, 2-, and 3-vessel and left main CAD was 7, 14, 21, 57 and 13%, respectively. Based on angiographic criteria, 69 of 78 patients (88%) with significant CAD had suitable coronary anatomy for CABG. Only 24 patients (31%) had coronary anatomy amenable to PTCA. CABG was performed in 19 patients with an operative mortality of 16% and major complication rate of 37%. PTCA was performed in 12 patients with a clinical success rate of 83%, mortality of 8% and major complication rate of 8%. It is concluded that in octogenarians with CAD, cardiac catheterization will often reveal coronary anatomy that is suitable for CABG but less suitable for PTCA. The morbidity and mortality associated with these interventions are high.