Related Experiment Videos
[Restenosis after percutaneous transluminal coronary angioplasty in the elderly--risk factor analysis]
Y Ishikawa1, Y Fujioka, Y Kitagawa
1First Department of Internal Medicine, Kobe University School of Medicine.
Insights
Restenosis after percutaneous transluminal coronary angioplasty (PTCA) is significantly higher in elderly patients compared to younger ones. Traditional coronary risk factors did not explain this increased restenosis rate in the elderly.
Area of Science:
- Cardiology
- Geriatrics
- Interventional Cardiology
Context:
- Percutaneous transluminal coronary angioplasty (PTCA) is increasingly used in elderly patients with coronary artery disease.
- Restenosis post-PTCA remains a significant limitation to the long-term effectiveness of this procedure.
- Reported restenosis rates after PTCA range from 25% to 43%.
Purpose:
- To investigate the relationship between restenosis and coronary risk factors specifically in elderly patients undergoing PTCA.
- To compare restenosis rates and associated risk factors between elderly (≥65 years) and younger (<65 years) patient groups.
Summary:
- A study analyzed 87 patients (29 elderly, 58 younger) who underwent PTCA and follow-up angiography.
- Restenosis (≥50% luminal narrowing) occurred in 69.0% of the elderly group versus 44.8% of the younger group (p < 0.0001).
- Despite lower cholesterol and apoB levels in the elderly, no significant differences in lipid profiles, apolipoproteins, or lipoprotein(a) were found between restenosis and non-restenosis subgroups within each age group. Traditional risk factors like atherosclerosis severity, vessel damage, diabetes, hypertension, and smoking did not influence restenosis rates.
Impact:
- The findings highlight a significantly higher restenosis rate in elderly patients post-PTCA.
- This study suggests that conventional coronary risk factors do not fully account for the increased restenosis observed in older individuals.
- Further research is needed to understand the underlying mechanisms driving higher restenosis rates in the elderly and to develop targeted preventive strategies.
Abstract:
Utilization of percutaneous transluminal coronary angioplasty (PTCA) has dramatically expanded even in the management of elderly patients with coronary artery disease. However, restenosis after successful PTCA remains the major problem limiting the long-term efficacy of the procedure. Reported restenosis rates vary from 25 to 43%. In order to determine the relationship of restenosis to coronary risk factors in the elderly, we analyzed the data in 87 patients who had undergone PTCA and angiography before and 3 to 6 months after PTCA. Of these, 29 patients were 65 years of age or older (elderly group) and 58 were less than 65 years of age (younger group). Restenosis, defined as a luminal narrowing of greater than 50% at follow-up time, was found in 20 of the elderly group (69.0%), and in 26 (44.8%) of younger group (p < 0.0001). Total cholesterol, LDL cholesterol, apolipoprotein B (apo B), and the ratio of apoB/apoA1 in the elderly group were significantly lower than those in the younger group. HDL cholesterol levels were lower than 40 mg/dl in both groups (not significant). Each group was subdivided into two types; restenosis type and non-restenosis type. There were no significant differences in serum lipid, apolipoprotein, and lipoprotein(a) levels between the 2 subtypes in each group. The degree of coronary atherosclerosis calculated by Gensini's method, the number of damaged coronary vessels, diabetes mellitus, hypertension, and smoking did not appear to affect the rate of restenosis in either group.(ABSTRACT TRUNCATED AT 250 WORDS)