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Published on: January 28, 2020
[Prognosis for medically treated elderly patients with coronary artery disease: analysis by the Cox model]
1Department of Medicine and Geriatrics, Kochi Medical School.
Insights
Age 70 and older is a significant prognostic factor in elderly patients with coronary artery disease. This finding is as important as the extent of coronary lesions for predicting cardiac events.
Area of Science:
- Cardiology
- Geriatric Medicine
- Medical Imaging
Context:
- Coronary artery disease (CAD) affects elderly populations, necessitating identification of prognostic factors.
- Established factors include lesion extent, cardiac function, and ischemia, but age's independent role requires further evaluation.
- Dipyridamole perfusion scintigraphy and coronary angiography are key diagnostic tools in CAD assessment.
Purpose:
- To evaluate the prognostic importance of age in elderly patients with CAD.
- To compare the predictive value of age against other known prognostic factors.
- To analyze cardiac events in medically treated elderly CAD patients.
Summary:
- A study analyzed 115 elderly patients (≥65 years) with CAD treated medically.
- Cardiac events occurred in 7.9% over a mean follow-up of 29 months.
- Age 70+ emerged as a significant independent prognostic factor, comparable to lesion extent.
Impact:
- Identifies advanced age (70+) as a critical prognostic indicator in elderly CAD patients.
- Suggests age should be considered equally with anatomical factors in risk stratification.
- Informs clinical decision-making and management strategies for older adults with CAD.
Abstract:
The prognostic importance of age among well-known prognostic factors such as extent of coronary artery lesions, cardiac function, and myocardial ischemia was evaluated in 147 elderly patients with coronary artery disease aged 65 years or older who underwent dipyridamole perfusion scintigraphy and coronary angiography. After excluding 32 patients who initially underwent percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass grafting (CABG), 115 patients who were initially treated medically were analysed by the Cox model for cardiac events during a mean follow-up period of 29 +/- 22 months. Among the 114 patients who were available for follow-up, nine patients (7.9%) had cardiac events, including five cardiac deaths and four non-fatal cardiac events (requiring PTCA or CABG). When the 114 patients were divided into three age-groups; 53 patients aged 65-69 years, 42 aged 70-74 years and 19 aged 75 years or older, the incidence of cardiac death was highest in those aged 75 years or older. Univariate analysis showed that age of 70 years or older (hazards ratio 15.15, p = 0.004), scintigraphic diffuse slow washout (hazards ratio 8.77, p = 0.002), and triple-vessel or left main trunk disease (hazards ratio 6.36, p = 0.05) were important prognostic factors. Multivariate analysis showed that scintigraphic diffuse slow washout (hazards ratio 6.33, p = 0.05), and triple-vessel or left main trunk disease (hazards ratio 11.94, p = 0.05) were statistically significant as independent prognostic factors. However, when age of 70 years or older was included in the analysis, it showed higher hazards ratio (21.21, p = 0.03) than that of scintigraphic diffuse slow washout (7.36) or triple-vessel or left main trunk disease (5.30). Age of 70 years or older may be a significant prognostic factor in elderly patients with coronary artery disease which has an equivalent importance to the extent of coronary lesions.
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