[Coronary angioplasty in the 8th and 9th decades of life: an effective technique for myocardial revascularization?].
OBJECTIVE
To evaluate the efficacy of percutaneous transluminal angioplasty (PTCA), as a revascularization procedure in patients with symptomatic coronary artery disease in the 8th and 9th decades of life.


METHODS
Four hundred and fifty-two elderly patients (mean age 74.7 years) underwent balloon dilation, between April 1982 and June 1990, at the Institute "Dante Pazzanese" of Cardiology. There were 70.4% male, 34.9% with high blood pressure, 18.8% smoked and 10.8% with diabetes. Ninety-four patients (20.7%) had previous myocardial infarction and systemic disorders were diagnosed in 14% (renal failure 5.1%, respiratory insufficiency 3.1%, rheumatic and bone disorders 1.1%, malignancy 4.2%, haematologic disorders 0.4%). One hundred and seventy-three (38.3%) had multivessel coronary artery disease whereas 84 (18.5%) had moderate to severe dysfunction of the left ventricle. PTCA was done according to the method described by Grüntzig, with the use of a "over the wire" (LPS, USCI, Mini Profile USCI, ACX ACS) balloon or a "on the wire" (Probe USCI, Axcel ACS) System.


RESULTS
Primary success was achieved in 406 (89.5%) patients where PTCA was done to dilate one vessel in 412, two vessels in 38 and three vessels in 2, accomplishing 494 dilated vessels. Major complications occurred in 14 (3.1%) patients, due to occlusion of the treated coronary artery. Emergency by-pass surgery was necessary in 5 (1.1%) patients, while 8 patients involved to acute myocardial infarction (1.8%), and 5 (1.1%) died. At the end of the late follow-up (mean 24.5 months) of 349 elderly patients (86% of the 406 successful dilated) 246 (70.5%) were asymptomatic, chest pain had recurred in 101 (28.9%) and 2 (0.6%) had myocardial infarction. Twenty-eight patients died during the follow-up, 14 of them (4.0%) due to cardiac causes. Late restenosis developed in 66 patients and 22 had progression of coronary atherosclerosis. Forty patients underwent a late PTCA, and 33 others underwent a late bypass surgery.


CONCLUSIONS
PTCA in patients in the 8th and 9th decade of life was a safe and efficient procedure (primary success rate about 90% and major complications of 3.1%). The late evolution showed satisfactory clinical results (70.5% of asymptomatic) low myocardial infarction rate (0.3% per year) and low incidence of cardiac death (2% per year). About 2/3 of the patients were free of any cardiac event (angina, myocardial infarction, by-pass surgery or death) at the end of the follow-up.
Sousa
A G
AG
Instituto Dante Pazzanese de Cardiologia, São Paulo.
Feres
F
F
Pinto
I M
IM
Tanajura
L F
LF
Mattos
L A
LA
Maneschi
L A
LA
Cano
M N
MN
Maldonado
G
G
Fontes
V F
VF
Sousa
J E
JE
D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000379:methods*; D003327:Coronary Disease / Q000209:etiology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009204:Myocardial Revascularization; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies
Angioplastia coronária em longevos na 8a. e 9a. décadas de vida: uma opção eficaz de revascularização?