Coronary arteriography in elderly patients: risk, therapeutic consequences and long-term follow-up

Elderly people comprise the fastest-growing segment of the German population. This study evaluated the benefit of coronary arteriography in the management of selected old-age patients suffering from symptomatic coronary heart disease.

From 1982 to 1992, with annually increasing frequency, coronary arteriography was performed in 398 patients with suspected or proven coronary artery disease who were 75 years of age or older.

Compared with 300 consecutive patients younger than 75 years, patients older than 75 years presented significantly more often with unstable angina, history of myocardial infarction, and multivessel disease; mean ejection fraction was significantly lower and risk of cardiac catheterization significantly higher. In more than half the older patients, balloon angioplasty (n = 130) or bypass surgery (n = 73) were judged to be indicated. Long-term prognosis was significantly worse with medical therapy: the 5-year survival rate was 58% for those receiving medical therapy, whereas it was 73% for those undergoing angioplasty, and 67% for those undergoing surgery. Multivariate analysis revealed history of diabetes and left ventricular ejection fraction as the most powerful predictors of death. Prognosis was significantly improved by surgery compared with medicine in patients with extensive coronary artery disease and impaired left ventricular function. More revascularized patients were free of angina at follow-up after a mean of 35 months, whereas intensity of antianginal medication was lower only in the surgically treated patients.

In about half the selected aged patients, coronary angioplasty or bypass surgery was deemed feasible. Long-term prognosis, however, was primarily determined by left ventricular ejection fraction and history of diabetes. Compared with medical therapy, bypass surgery improved prognosis in patients with extensive coronary artery disease and impaired ventricular function. Interventions were effective in alleviating anginal complaints and reducing the need for antianginal drugs.