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[Treatment of coronary heart disease in the aged. When balloon dilatation, when surgery?]
F Schwarz1, M Müller-Leile, H Störger
1Abteilung Kardiologie, Rotes-Kreuz-Krankenhaus Frankfurt.
Insights
Older patients with coronary heart disease can benefit from percutaneous transluminal coronary angioplasty, especially for single or double vessel disease. Triple vessel disease in the elderly often requires bypass surgery.
Area of Science:
- Cardiology
- Interventional Cardiology
- Geriatric Medicine
Context:
- Coronary heart disease (CHD) affects millions globally, with an aging population experiencing increased prevalence.
- Percutaneous transluminal coronary angioplasty (PTCA) is a common treatment for CHD, but its efficacy and safety in elderly patients require ongoing evaluation.
- Coronary angiography is crucial for diagnosing CHD and guiding treatment strategies.
Purpose:
- To evaluate the suitability and outcomes of balloon angioplasty (PTCA) in elderly patients with coronary heart disease.
- To compare treatment patterns and results between older (≥65 years) and younger (<65 years) patients with CHD.
- To identify specific patient subgroups within the elderly population who may benefit most from PTCA versus other interventions.
Summary:
- A study of 3029 CHD patients found that while triple vessel disease was more common in the elderly (42% vs 26%), PTCA success and complication rates were similar across age groups for single and double vessel disease.
- Elderly patients with single vessel disease were treated conservatively (50%) or with PTCA (49%), while those with triple vessel disease predominantly underwent surgery (69%).
- The study indicates that elderly patients with one or two diseased coronary arteries have comparable PTCA outcomes to younger patients, but triple vessel disease often necessitates surgical intervention.
Impact:
- Provides evidence supporting the use of PTCA in carefully selected elderly patients with less extensive coronary artery disease.
- Informs clinical decision-making regarding the optimal treatment strategy (PTCA vs. surgery vs. conservative management) for elderly patients with varying degrees of CHD.
- Highlights the need for individualized treatment approaches based on the extent of coronary artery disease and patient age.
Abstract:
Data from 3029 consecutive patients (2474 men, 555 women, mean age 59 [20-88] years) in whom coronary heart disease had been diagnosed by coronary angiography were studied with the object of identifying those patients in the older age group who are suitable for treatment by balloon angioplasty. There were 884 patients with a mean age of 70 (65-88) years, and 2145 patients with a mean age of 54 (20-64) years. Single vessel disease was less common in older patients (30% vs 44%; P less than 0.001), double vessel disease was equally common in both groups (28% vs 30%) and triple vessel disease was commoner in the elderly group (42% vs 26%; P less than 0.001). For elderly patients with single vessel disease conservative treatment was chosen in 50%, angioplasty in 49% and operative treatment in only 1%. Of elderly patients with involvement of two arteries, 44% were treated conservatively, 40% by angioplasty and 16% surgically. Of elderly patients with triple artery disease, 23% were treated conservatively, 8% by angioplasty and 69% operatively. This pattern was similar to that among younger patients. The success rate and the incidence of complications after percutaneous transluminal coronary angioplasty were similar in both age groups. In elderly patients with disease of only one or two coronary arteries the prospects of success and the risks are comparable to those in younger patients, but patients with triple artery disease often need bypass surgery.