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Recurrent ischemic heart disease: the effect of advancing age
R V Pellegrini1, R F Di Marco, A M Werner
1Department of Cardiovascular Surgery, Mercy Hospital of Pittsburgh, Pennsylvania 15219-5166.
Insights
Repeat coronary artery revascularization is a safe option for older patients with recurrent ischemic heart disease. Advancing age does not increase risks, and factors like smoking and diabetes indicate higher recurrence risk.
Area of Science:
- Cardiology
- Vascular Surgery
- Geriatric Medicine
Background:
- A significant number of patients develop recurrent ischemic heart disease after initial coronary artery revascularization.
- Evaluating the safety and efficacy of repeat procedures in an aging population is crucial.
Purpose of the Study:
- To assess the impact of advancing age on risk factors, morbidity, and mortality associated with repeat coronary artery revascularization.
- To determine if age is a contraindication for repeat surgical intervention.
Main Methods:
- Retrospective analysis of 168 patients evaluated for recurrent ischemic heart disease post-coronary artery revascularization between January 1, 1988, and June 30, 1992.
- Comparison of outcomes between patients undergoing non-operative management (44 patients) and repeat revascularization (124 patients).
Main Results:
- Advancing age was not found to be a contraindication for repeat coronary artery revascularization.
- The average interval between initial and repeat revascularization was eight years.
- Factors such as tobacco use, recent myocardial infarction, diabetes mellitus, and high cholesterol levels are indicators of recurrent disease and increased surgical risk.
Conclusions:
- Repeat coronary artery revascularization is a viable treatment option for elderly patients with recurrent ischemic heart disease.
- While younger patients show disease progression in various vascular beds, age itself does not preclude successful repeat revascularization.
- Identifying and managing risk factors is essential for optimizing outcomes in patients requiring repeat coronary artery revascularization.
Abstract:
Four thousand four hundred and thirty open heart operations were performed at Mercy Hospital of Pittsburgh from January 1, 1988, to June 30, 1992. During that period, 168 patients were evaluated for recurrent ischemic heart disease after prior coronary artery revascularization. Forty-four were treated non operatively, the mode of therapy being transluminal angioplasty or medical management. The remaining 124 patients underwent repeat coronary revascularization. An attempt was made to define the impact of advancing age on the magnitude of risk factors, morbidity, and mortality. Advancing age is not a contraindication to repeat coronary artery revascularization. The average interval between the initial operation and the need for repeat revascularization is eight years. Younger patients have progression of their coronary artery disease, but progression of the arteriosclerotic process is in their extracranial cerebral arteries, renal arteries, and aortic segments as well as the coronary arteries. The utilization of tobacco, recent myocardial infarction, diabetes mellitus, and elevation of cholesterol are strong indicators for recurrent disease and add to the risk of repeat surgical intervention.