Related Experiment Videos
Percutaneous transluminal coronary angioplasty in elderly patients
I Shapira1, A Frimerman, U Rosenschein
1Department of Cardiology, Tel Aviv E. Sourasky Medical Center, Israel.
Insights
Percutaneous transluminal coronary angioplasty (PTCA) is safe and effective for elderly patients with one- or two-vessel coronary artery disease. Results for three-vessel disease were less encouraging, but age is not a contraindication for PTCA.
Area of Science:
- Cardiology
- Interventional Cardiology
- Geriatric Medicine
Background:
- Elderly patients (≥75 years) represent a growing population undergoing cardiovascular interventions.
- Percutaneous transluminal coronary angioplasty (PTCA) is a common revascularization strategy, but its efficacy and safety in the oldest patients require evaluation.
Purpose of the Study:
- To assess the safety and effectiveness of PTCA in patients aged 75 years and older.
- To evaluate long-term outcomes and identify predictors of success or failure in this specific demographic.
Main Methods:
- Retrospective analysis of 56 patients aged 75+ who underwent PTCA between 1984 and 1991.
- Data collected included patient demographics, coronary artery disease severity, left ventricular ejection fraction, anginal class, procedural details, complications, and long-term follow-up.
Main Results:
- The average age was 76.7 years, with 84% males. Most patients presented with severe angina (Class III/IV).
- Procedural success rate was 91%. Complications included severe dissection (5 patients), death (1), myocardial infarction (1), and emergency bypass (1).
- Long-term follow-up (mean 21 months) in 51 patients showed 1 late cardiac death, 9 restenosis events requiring repeat PTCA, and 2 bypass surgeries. 70% of patients were asymptomatic or improved.
Conclusions:
- PTCA is a safe and effective treatment for elderly patients with one- and two-vessel coronary artery disease, offering excellent long-term results.
- Age alone is not a contraindication for PTCA.
- Outcomes in elderly patients with three-vessel disease undergoing PTCA were less favorable, suggesting careful patient selection is crucial.
Abstract:
Fifty-six patients aged 75 years and older underwent percutaneous transluminal coronary angioplasty (PTCA) at our institution from 1984 to 1991. The average age was 76.7 +/- 1.5 years, and 84% of the patients were males. Single-vessel disease occurred in 21 patients, double-vessel disease in 16, and three-vessel disease in 19 patients. The mean left ventricular ejection fraction was 57 +/- 5%, and 8 patients had an ejection fraction of < 40%. The anginal functional class was I in 1 patient, II in 3, III in 6, and IV in 46 patients. Single-vessel PTCA was attempted in 43 patients, two-vessel PTCA in 8, and three-vessel PTCA in 5 patients. Revascularization was complete in 35% of the patients, incomplete in 57, and no revascularization was obtained in 8% of the patients. Ninety-one percent of the patients had a successful procedure. In 5 patients there was severe dissection, 1 patient died, 1 patient had an acute myocardial infarction, and 1 patient had emergency bypass surgery. Long-term follow-up (6-96 months, mean 21 +/- 4) in the 51 successfully treated patients revealed late cardiac death in 1 patient, repeated PTCA for restenosis in 9, and coronary bypass surgery in 2 patients. Twenty-two patients were asymptomatic, 12 had improved symptoms, and 5 remained symptomatic. PTCA appears to be a safe and effective treatment in elderly patients with one- and two-vessel disease, with excellent long-term results. Age is not a contraindication to PTCA. The results in elderly patients with three-vessel disease are less encouraging.