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Predicting early and intermediate-term outcome of coronary angioplasty in the elderly
R C Thompson1, D R Holmes, B J Gersh
1Division of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL 32224.
Insights
The number of diseased coronary artery segments predicts percutaneous transluminal coronary angioplasty (PTCA) failure in elderly patients. This helps stratify risk for better PTCA appropriateness in older individuals.
Area of Science:
- Cardiology
- Geriatric Medicine
- Interventional Cardiology
Background:
- Elderly patients undergoing coronary angioplasty face increased risks of death and angina recurrence despite high technical success rates.
- Identifying predictors of PTCA failure is crucial for risk stratification in patients over 65.
Purpose of the Study:
- To determine baseline variables predicting early and intermediate-term failure of percutaneous transluminal coronary angioplasty (PTCA).
- To enable effective risk stratification for elderly patients undergoing PTCA.
Main Methods:
- Analysis of 982 patients aged 65+ undergoing PTCA between 1980-1990 with a mean 25-month follow-up.
- Utilized univariate and multivariate logistic regression to identify independent predictors for various adverse outcomes.
Main Results:
- The number of diseased coronary artery segments was the strongest predictor of PTCA failure, more so than advanced age.
- Concomitant medical illnesses predicted late outcomes but not in-hospital events.
- Significant differences in event rates were observed between the lowest and highest risk quintiles for both early and late adverse outcomes.
Conclusions:
- The study successfully stratifies elderly patients into high and low-risk groups for PTCA success.
- Identifies specific patient characteristics to guide the appropriate selection of elderly individuals for PTCA.
Background:
Although the technical success rate of coronary angioplasty in the elderly in high, very old patients have increased risk of procedure-related death and late recurrence of severe angina. We proposed to determine baseline variables that predict early and intermediate-term failure of percutaneous transluminal coronary angioplasty (PTCA) in patients more than 65 so we could effectively stratify risk.
Methods And Results:
We studied 982 patients at least 65 years old who had urgent or elective PTCA (1980 through 1990). Follow-up (mean, 25 months) was obtained for all patients. Multiple baseline variables were analyzed with univariate and multivariate logistic regression to select independent ones to fit predictive models for in-hospital death or myocardial infarction (overall rate, 6.3%), total in-hospital adverse outcome (overall rate, 18.7%), cumulative survival free of myocardial infarction (overall rate, 15% at 3 years), and cumulative survival free of late nonfatal myocardial infarction, bypass surgery, repeat PTCA, or recurrent severe angina (overall rate, 47% at 3 years). The most heavily weighted parameter in the probability regression equation for each end point was the number of diseased coronary artery segments with at least 70% stenosis. Advanced age was less important. The number of concomitant medical illnesses was predictive of late outcome but not early in-hospital events. Lowest risk quintile versus highest risk quintile event rate was 2.9% versus 14% for acute myocardial infarction or death and 17.2% versus 29% for cumulative in-hospital events. For posthospital events at 3 years' follow-up, lowest risk quintile death or myocardial infarction rate was 4% versus 33% for highest risk quintile. For cumulative late adverse events at 3 years, the event rate was 28% versus 63% for the highest risk quintile.
Conclusions:
These results stratify patients at high and low risk of early and intermediate-term success after PTCA and identify elderly patients in whom PTCA is most appropriate.