Coronary angiography in octogenarians: results and implications for revascularization

To determine the risks and the consequences of coronary angiography performed on octogenarians with symptomatic coronary artery disease.

In order to define angiographic findings, procedural complications, and therapeutic consequences, a retrospective evaluation was made of 115 consecutive patients with angina, aged 80 or above, who underwent coronary angiography in our institution between 1988 and 1992.

In all, 115 patients (68 men) aged 82 +/- 2 years, 70% with unstable angina, underwent coronary angiography corresponding to 1.4% of all the procedures performed between 1988 and 1992. Three-vessel or left main coronary artery disease, or both, was found in 42% of cases, but this proportion decreased over the years. Revascularization by means of percutaneous transluminal angioplasty (PTCA) or bypass grafting followed angiography in 54% of cases. Use of revascularization has markedly increased, from 33% in 1988 to 64% in 1992 (P < 0.05), and now tends to be performed more often by PTCA. Eight patients (7%) suffered minor periprocedural complications and 8 patients (7%) died in the hospital, but none of the deaths was directly related to the diagnostic procedure itself. At follow-up (28 +/- 16 months), 68% and 44% of the survivors were free of angina after revascularization and medical treatment, respectively (P < 0.05), and there was a nonsignificant trend for better survival after revascularization. Of the survivors, 80% were able to pursue an independent life.

Coronary angiography may be done in symptomatic octogenarians with an acceptably low complication rate. Following diagnostic evaluation, revascularization procedures are performed in an increasing proportion of patients, and despite a relatively high procedural complication rate, they result in definite symptomatic improvement.