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Single (culprit) vessel disease in octogenarians with acute myocardial infarction and unstable angina
K M U1, V Mantadilok, A K Fatterpaker
1Internal Medicine, St. Agnes Hospital, Baltimore, USA.
Insights
Single vessel disease in octogenarians with acute myocardial infarction or unstable angina has a favorable outcome with revascularization. Treatment of single vessel disease in this age group is crucial for reducing mortality.
Area of Science:
- Cardiology
- Geriatric Medicine
Background:
- Coronary artery disease (CAD) in octogenarians is often presumed to involve multiple vessels.
- The clinical significance and outcomes of single vessel disease in this elderly population are less understood.
Purpose of the Study:
- To evaluate the importance of single vessel disease in octogenarians presenting with acute myocardial infarction (AMI) or unstable angina.
- To assess the outcomes of revascularization procedures for single vessel disease in this demographic.
Main Methods:
- Retrospective study of 70 patients aged 80+ admitted for AMI or unstable angina.
- Cardiac catheterization was performed on 19 patients to assess coronary artery disease.
- Revascularization procedures included percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass grafting (CABG).
Main Results:
- Of 19 patients with cardiac catheterization, 10 had single vessel disease, 8 had multivessel disease.
- No in-hospital mortality occurred among 14 PTCA and 3 CABG procedures.
- Overall mortality was 12.9%, with no deaths in the single vessel disease group compared to 15.7% in those without catheterization.
Conclusions:
- Single vessel disease in octogenarians with AMI or unstable angina has a significantly better prognosis.
- Revascularization for single vessel disease in octogenarians is safe and effective in reducing mortality.
- Recognition and treatment of single vessel disease are vital for improving outcomes in elderly CAD patients.
Abstract:
It is generally thought that coronary artery disease (CAD) in octogenarians would involve multiple vessels. The purpose of the current study was to determine the relative importance of single vessel disease in octogenarians with acute myocardial infarction (AMI) and unstable angina and its outcome from a revascularization procedure such as percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass grafting (CABG). Our study included 70 patients (25 men, 45 women) aged 80 or older (mean, 84.5 +/- 0.5) admitted for the first time to the St. Agnes Hospital coronary care unit during 1994 for AMI or unstable angina. Patients admitted primarily for congestive heart failure, cardiogenic shock, hypertensive heart disease, or cardiomyopathy were excluded. Fifty patients (71.4%) had AMI and 20 (28.6%) had unstable angina. Of the 19 patients who had cardiac catheterization done, 10 had single vessel disease, 8 had flow-limiting disease in 2 or more coronary arteries, and 1 had no flow-limiting disease. The mean ejection fraction was 56.5 +/- 6.9 in patients with single vessel disease, 48.0 +/- 3.3 in those with multiple vessel disease, and 38.7 +/- 1.7 in those who did not have cardiac catheterization done. Fourteen PTCA (20%) and 3 CABG (4.3%) were performed without inhospital mortality from the procedures. There were 9 deaths (12.9%) overall: none among 10 patients with single vessel disease, 1 (12.5%) among 8 patients with widespread CAD, and 8 (15.7%) among 51 patients who did not have cardiac catheterization. Study results emphasize the need for recognition and treatment of single vessel disease by revascularization procedures to reduce mortality from CAD in octogenarians.