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Coronary balloon angioplasty for elderly patients with severe angina
Insights
Balloon coronary angioplasty effectively relieves severe angina in elderly patients with refractory symptoms. This procedure offers significant symptom improvement and reduces the need for surgical revascularization in older adults.
Area of Science:
- Cardiology
- Interventional Cardiology
- Geriatric Medicine
Background:
- Elderly patients (≥65 years) often present with severe angina refractory to medical management.
- Multivessel disease is common in this population, complicating treatment decisions.
- Percutaneous transluminal coronary angioplasty (PTCA) offers a potential therapeutic option.
Purpose of the Study:
- To evaluate the efficacy and safety of balloon coronary angioplasty for severe angina in elderly patients.
- To assess the impact of PTCA on symptom relief and need for revascularization in this demographic.
- To analyze procedural success rates, complications, and long-term outcomes.
Main Methods:
- Retrospective analysis of 65 angioplasty procedures in 51 elderly patients (≥65 years) from February 1983 to December 1986.
- Patients had medically refractory angina, predominantly Canadian Cardiovascular Society class III/IV (89%) and multivessel disease (68%).
- Procedures focused on stenosis (80%) or occlusion (20%), with no attempt to treat all visible lesions.
Main Results:
- Initial success rate for stenosis was 75% and for occlusion was 44%.
- Major complications occurred in 6.2% (Q wave MI 4.6%, emergency surgery 4.6%, death 4.6%).
- At 4-month median follow-up, 37% were asymptomatic and 76% improved symptomatically. Restenosis occurred in 28% of lesions. Patients with failed angioplasty had a 50% revascularization rate versus 11% for successful procedures.
Conclusions:
- Balloon coronary angioplasty is an effective treatment for severe angina in elderly patients.
- The procedure provides significant symptom relief and reduces the need for subsequent surgical revascularization.
- Careful patient selection and procedural technique are crucial for optimizing outcomes in this population.
Abstract:
From February 1983 to December 1986, 65 angioplasty procedures were attempted in 51 patients aged 65 or more. All had angina refractory to medical treatment and 89% of procedures were performed in patients in Canadian Cardiovascular Society angina class III or IV. Sixty eight per cent of patients had multivessel disease. Angioplasty was attempted on a single vessel in 52 instances (80%) and on multiple vessels in 13 (20%). The initial success rate was 75% for stenosis and 44% for occlusion. No attempt was made to treat all visible lesions in every case. At least one major complication occurred in 6.2% of the procedures: Q wave infarction in 4.6%, emergency surgery in 4.6%, and death in 4.6%. After a median follow up of four months (range 1-31) 37% of the patients in whom the procedure was initially successful were asymptomatic and 76% were improved by at least one Canadian Cardiovascular Society angina class. Angiographic restenosis occurred in 28% of treated lesions and 39% of patients had at least one recurrent stenosis. Among the patients with an initially successful procedure, 11% needed surgical revascularisation during the follow up period compared with 50% of those with a failed angioplasty. Balloon coronary angioplasty can be an effective form of treatment for the relief of severe angina in elderly patients.