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[Myocardial revascularization in geriatric patients]
A Garachemani1, B Kipfer, M Fleisch
1Kardiologische Abteilung, Universitätsklinik, Inselspital Bern.
Schweizerische Medizinische Wochenschrift
|March 15, 1997
Summary
Percutaneous transluminal coronary angioplasty (PTCA) offers high immediate success for elderly patients over 75. While repeat procedures are common, patient satisfaction and quality of life significantly improve after PTCA or coronary artery bypass grafting (CABG).
Area of Science:
- Cardiology
- Geriatric Medicine
- Interventional Cardiology
Background:
- Elderly patients (over 75) often present with complex coronary artery disease.
- Revascularization strategies, including percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass grafting (CABG), are crucial for managing these patients.
- Outcomes and patient-reported benefits of these procedures in the very elderly require careful evaluation.
Purpose of the Study:
- To compare the outcomes of percutaneous transluminal coronary angioplasty (PTCA) versus surgical revascularization (CABG) in patients over 75 years of age.
- To assess the immediate success rates, complication profiles, and long-term results of PTCA in this elderly cohort.
- To evaluate patient satisfaction and quality of life following myocardial revascularization.
Main Methods:
- Retrospective analysis of 71 patients over 75 undergoing PTCA.
- Comparison with 55 patients over 75 undergoing CABG between 1992-1995.
- Evaluation of clinical success, lesion success, complications, mortality, hospital stay, repeat revascularization rates, and long-term follow-up.
Main Results:
- PTCA demonstrated high immediate clinical (92%) and lesion (93%) success rates with low in-hospital mortality (1%) and complications (5%).
- CABG group had higher in-hospital mortality (7%) and major complications (45%), likely due to poorer preoperative condition.
- Long-term mortality was 10% in both groups; however, 23% of PTCA patients required repeat revascularization compared to 2% in the CABG group.
- Despite repeat procedures, 92% of long-term survivors reported improved quality of life, with most leading active lives.
Conclusions:
- Percutaneous transluminal coronary angioplasty (PTCA) is a safe and effective option for selected elderly patients (over 75) with a high immediate success rate and low complication risk.
- While long-term recurrence rates necessitate repeat revascularization in a significant proportion of PTCA patients, overall patient satisfaction and quality of life are excellent.
- Both PTCA and CABG can enable elderly patients to lead active and independent lives, highlighting the importance of patient selection and shared decision-making.