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Morbidity and mortality rates in elderly patients undergoing percutaneous coronary transluminal angioplasty
J Lindsay1, V M Reddy, E E Pinnow
1Section of Cardiology, Washington Hospital Center, Washington, DC 20010.
Insights
Elderly patients undergoing percutaneous transluminal coronary angioplasty (PTCA) face higher complication risks, including death and heart attack. While successful dilatation is similar, advanced age independently predicts adverse outcomes after PTCA.
Area of Science:
- Cardiology
- Interventional Cardiology
- Geriatric Medicine
Background:
- Percutaneous transluminal coronary angioplasty (PTCA) is a common procedure for coronary artery disease.
- While successful dilatation rates are comparable across age groups, elderly patients exhibit increased complication risks.
- Older patient cohorts undergoing PTCA often present with more comorbidities and unstable angina, further elevating procedural risks.
Purpose of the Study:
- To evaluate the impact of advanced age on the outcomes and complications of percutaneous transluminal coronary angioplasty (PTCA).
- To identify specific risk factors associated with PTCA in patients aged 75 years and older.
Main Methods:
- Retrospective analysis of 3199 PTCA procedures performed between January 1991 and September 1992.
- Inclusion of 474 patients aged 75 years or older (14.8% of the cohort).
- Statistical evaluation to determine age as an independent risk factor for adverse events.
Main Results:
- Age was identified as an independent risk factor for mortality, acute myocardial infarction, need for blood transfusion, and arterial repair post-PTCA.
- Successful lesion dilatation, need for emergency coronary bypass surgery, or repeat PTCA were not significantly associated with patient age.
- No age-related increase in in-hospital reclosure rates was observed, consistent with previous findings.
Conclusions:
- Advanced age (≥75 years) is an independent predictor of adverse outcomes following PTCA, despite similar rates of successful dilatation.
- Elderly patients are less tolerant of PTCA complications due to more severe coronary disease and higher prevalence of comorbidities.
- These findings underscore the heightened risks associated with PTCA in the geriatric population, necessitating careful patient selection and management.
Abstract:
Although successful dilatation of a target lesion by means of percutaneous transluminal coronary angioplasty (PTCA) can be attained as frequently in elderly as in younger patients, elderly patients have a higher risk of complications. Furthermore, cohorts of patients older than 75 years and undergoing PTCA include more women and more cases of unstable angina, factors that increase the risk of complications. Included in this analysis of 3199 PTCAs performed between January 1991 and September 1992 were 474 (14.8%) patients who were > or = 75 years old. Age was an independent risk factor for death, acute myocardial infarction, need for transfusion, and need for arterial repair after PTCA. The frequency of successful dilatation of individual lesions, emergency coronary bypass surgery, or repeated PTCA of the same lesion was not related to age. In previous studies no association has been demonstrated between age and increased risk of in-hospital reclosure. The presence of more severe coronary disease and of the greater frequency of coexisting morbid conditions makes elderly patients less able to tolerate unsuccessful or complicated PTCA.