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Management of unstable angina in patients over 75 years old
T Eggeling1, W Hölz, H H Osterhues
1Cardiology Clinic Haubrichforum, Cologne, Germany.
Insights
For elderly patients with unstable angina, coronary artery bypass grafting (CABG) shows better long-term clinical outcomes than percutaneous transluminal coronary angioplasty (PTCA), despite similar mortality rates.
Area of Science:
- Cardiology
- Interventional Cardiology
- Geriatric Cardiology
Background:
- Optimal management strategies for unstable angina in elderly patients (over 75 years) remain under investigation.
- Percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass grafting (CABG) are established revascularization methods.
Purpose of the Study:
- To compare the efficacy and safety of PTCA versus CABG in patients over 75 years with unstable angina.
- To identify the preferred revascularization strategy for this specific patient demographic.
Main Methods:
- A comparative study evaluating early and late results of PTCA (n=51) and CABG (n=53) in elderly patients with unstable angina.
- Groups were matched for age, sex, symptom presentation, left ventricular ejection fraction, and comorbidities.
- Left main coronary artery stenosis was more prevalent in the CABG group.
Main Results:
- Both PTCA and CABG demonstrated similar procedural success rates (91% vs 94%) and hospital mortality (4% vs 6%).
- Complication rates (myocardial infarction, stroke, renal failure) were comparable between groups.
- CABG patients required more blood transfusions (17% vs 2%).
- Long-term follow-up revealed similar mortality (4% vs 8%), but significantly fewer cardiac readmissions (17% vs 31%) and repeat interventions (4% vs 18%) in the CABG group.
- Fewer patients in the CABG group developed recurrent unstable angina (8% vs 21%).
Conclusions:
- PTCA and CABG offer comparable short- and long-term mortality benefits for elderly patients with unstable angina.
- CABG is associated with superior long-term clinical outcomes, including reduced symptom recurrence, hospital readmissions, and need for repeat interventions.
Background:
Although there have been reports of successful percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass grafting (CABG) in elderly patients, few data are available on the optimal management of unstable angina in such patients. This study was therefore designed to identify the preferred revascularization strategy in patients with unstable angina over 75 years of age.
Methods:
Early and late results were evaluated for patients over 75 years with unstable angina undergoing PTCA (n = 51) or CABG (n = 53). The two groups were comparable with respect to age, sex distribution, clinical manifestation of symptoms, left ventricular ejection fraction and accompanying non-cardiac diseases. In the CABG group, significantly more patients had left main coronary artery stenosis (13 and 2%, respectively).
Results:
Both PTCA and CABG treatment showed similar procedural success rates (91 and 94% respectively) and hospital mortality rates (4 and 6% respectively). Procedural complications were comparable regarding Q-wave myocardial infarction, stroke, renal failure and vascular complications. Patients undergoing CABG received significantly more blood transfusions than those undergoing PTCA (17 and 2% respectively). During follow-up, the mortality rate was comparable in both groups (4% with CABG and 8% with PTCA), but significantly fewer patients in the CABG group developed unstable angina (8 versus 21% in the PTCA group), fewer patients were readmitted to hospital for cardiac reasons (CABG group 17%, PTCA group 31%) and fewer patients needed repeat coronary interventions (CABG group 4%, PTCA group 18%).
Conclusion:
Both PTCA and CABG were comparable with regard to short- and long-term mortality, but CABG treatment was favourable with regard to clinical symptoms, readmission to hospital and repeat coronary interventions.