Percutaneous transluminal coronary angioplasty in patients 70 years of age or older: 12 years' experience.
OBJECTIVE
To evaluate the short and long term results of coronary angioplasty in patients aged 70 years and older and identify the determinants of long-term survival.


METHODS
A retrospective analysis of clinical, angiographic, and procedure related variables on a consecutive series of patients.


METHODS
163 patients aged 70 years and older (mean (range) age 73 (70-83) years; 63% men) who underwent a first coronary angioplasty procedure between 1981 and 1993.


RESULTS
Procedural success was achieved in 82% of patients. Four patients (2%) died, three (2%) had a myocardial infarction, and five (3%) underwent emergency coronary artery bypass surgery. Complete follow up data were available for all patients (median (range) 35 (2-146) months). During the follow up period 16 patients (10%) died, two (1%) suffered non-fatal myocardial infarction, and 12 (7%) underwent elective coronary artery bypass surgery. A second angioplasty procedure was performed in 24 patients (15%). The cumulative probability of survival was 90.7% at 1 year and 83.4% at 5 years. Survival free from myocardial infarction, bypass surgery, and repeat angioplasty at 1 and 5 years was 68.2% and 56.0%, respectively. Proportional hazards regression analyses identified incomplete revascularisation as the only independent predictor of poorer overall survival (P = 0.04) and event free survival (P < 0.001). At census, of the 143 survivors, 75 (52%) were asymptomatic, 58 (41%) had mild angina, and only 10 (7%) complained of grade III or IV angina. Some 112 patients (78%) improved by at least two angina grades.


CONCLUSIONS
Coronary angioplasty can be performed safely in the elderly and provides good symptomatic relief and favourable long-term outcome. Complete revascularisation may not be necessary if the primary goal is to achieve symptomatic relief, but incomplete revascularisation is associated with poorer long-term survival.
Tan
K H
KH
Department of Cardiology, Guy's Hospital, London.
Sulke
N
N
Taub
N
N
Karani
S
S
Sowton
E
E
D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D003327:Coronary Disease / Q000401:mortality / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008485:Medical Audit; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome