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Results of direct percutaneous transluminal coronary angioplasty in octogenarians
S B Laster1, B D Rutherford, L V Giorgi
1Mid America Heart Institute of St. Luke's Hospital, Kansas City, Missouri, USA.
Insights
Direct percutaneous transluminal coronary angioplasty (PTCA) is safe and effective for octogenarians with acute myocardial infarction. This high-risk group shows favorable outcomes with PTCA compared to other therapies.
Area of Science:
- Cardiology
- Interventional Cardiology
- Geriatric Medicine
Background:
- Acute myocardial infarction (AMI) in octogenarians presents unique challenges.
- Thrombolytic therapy in this age group reduces mortality but increases stroke and hemorrhage risks.
- Limited data exist on the efficacy and safety of direct percutaneous transluminal coronary angioplasty (PTCA) in patients aged 80 years and older.
Purpose of the Study:
- To evaluate the acute and long-term outcomes of direct PTCA in octogenarian patients with AMI.
- To compare the safety and efficacy of direct PTCA with existing therapies for AMI in the elderly.
Main Methods:
- Retrospective analysis of 55 patients aged >= 80 years who underwent direct PTCA between 1980 and 1993.
- Data collected included patient demographics, infarct location, presence of cardiogenic shock, time to reperfusion, procedural success, in-hospital complications, and mortality.
- Long-term follow-up included 30-day and 1-year survival rates.
Main Results:
- Direct PTCA was successful in 96% of patients (53/55).
- In-hospital mortality was 16% (9/55), with higher rates in patients presenting with cardiogenic shock (67%).
- Stroke and emergent bypass surgery were absent; bleeding complications occurred in 7% of patients. One-year survival was 67%.
Conclusions:
- Direct PTCA can be performed safely in octogenarians with AMI, achieving a high success rate.
- The clinical outcomes of direct PTCA in this high-risk population are favorable compared to thrombolytic or medical therapy.
- PTCA offers a viable reperfusion strategy for elderly patients experiencing acute myocardial infarction.
Abstract:
Direct percutaneous transluminal coronary angioplasty (PTCA) has emerged as effective reperfusion therapy for acute myocardial infarction; however, few data exist on its use in octogenarians. Thrombolytic therapy in this age group has reduced early mortality from approximately 30% to 20%, but is associated with an increased risk of stroke and major hemorrhage. We analyzed the acute and long-term results of direct PTCA performed on patients aged > or = 80 years at our institution between 1980 and 1993. The study group consisted of 55 patients (mean patient age 83.3 +/- 2.3 years). Infarcts were anterior in 27 patients (49%). Cardiogenic shock was present in 6 patients (11%). The mean time to reperfusion was 4.3 +/- 2.8 hours. Direct PTCA was successful in 53 patients (96%). There were no emergent bypass operations. In-hospital death occurred in 9 patients (16%), including 4 of 6 (67%) presenting in cardiogenic shock and 5 of 49 (10%) who were hemodynamically stable on presentation. Repeat PTCA for recurrent ischemia was performed in 6 patients (11%). There were no strokes during hospitalization. Bleeding complications requiring blood transfusion were present in 4 patients (7%). Thirty-day mortality was 16% and 1-year actuarial survival was 67%. Direct PTCA in patients aged > or = 80 years can be performed safely with a high procedural success rate. The clinical outcome with PTCA in this high risk subset of patients compares favorably with that reported previously for both thrombolytic and medical therapy.