[Long-term results of coronary balloon angioplasty in various age groups].
Some data indicate that natural history of coronary artery disease in younger patients is characterised by high dynamics and therefore the long-term results of revascularisation procedures have generally poorer outcome. To verify this we compared the early and the long-term results of balloon angioplasty in 630 consecutive patients divided into four age groups: < 40 years (77 patients), 41-50 years (247 patients), 51-60 years (160 patients) and > 60 years (146 patients). Groups differed significantly in many clinical factors: higher proportion of women and unstable angina were encountered in older groups, while higher frequency of hypertension, hypertriglycerydaemia, current smoking, familial history of angina, prior myocardial infarction, were more often observed in younger patients. Groups did not differ in such angiographic factors as: global ejection fraction (EF), presence of multivessel disease, type of dilated lesions and vessels, multilesion PTCA, except higher frequency of EF < 50% in patients < 40 years of age. Immediate results of angioplasty did not differ significantly between the respective age groups: success rate was 87-94%, complications rate between 4.5% and 6.5%, complete revascularisation was achieved in 46-61% patients (NS). In the mean 5-year follow-up period repeated angiography was carried out with comparable frequency in about half of the studied patients (NS). Restenosis rate equalled 21-42% and significantly increased with the patients' age (p = 0.02 in chi 2, 0.009 in log-rank test), the related reinterventions rate likewise (p = 0.05 in chi 2, 0.009 in log-rank test). We did not observe any differences among the respective groups with regard to significant atherosclerosis progression, which was encountered in 15-19% of patients (NS). Survival rate did not differ significantly either, being in fact quite high (96-99%). Myocardial infarction in follow-up significantly more frequently (p = 0.01) occurred in patients < 40 years of age, in comparison with patients > 60 years of age, although it did not differ significantly in terms of overall test for independence (p = 0.3) and log-rank test (p = 0.07). The frequency of major coronary events significantly increased according to patients' age as opposed to the event-free survival (p = 0.02 in both tests). Uni and multivariate analysis confirmed that age over 50 years is an independent factor of restenosis, reintervention, and major coronary event in follow-up. Patients functional status at the end of observation period, according to CCS criteria, proved that in the older age groups the percentage of patients with none, or minor anginal complaints decreased, whereas the proportion of patients exhibiting the symptoms of severe angina (Class III and IV) significantly increased (p = 0.006).


CONCLUSIONS
Balloon angioplasty offered similar short-term outcome in all age groups, as well as the survival rate during the 5-year follow-up period. Frequency of restenosis significantly increased in older patients especially the ones over 50 years of age; this in turn resulting in a higher reinterventions rate among them. On the other hand, patients below 40 years of age suffered more frequently from myocardial infarction during the follow-up period. Major coronary events were more frequent in patients over 50 years of age. Better functional status was observed in younger patients at the end of observation period.
Przewłocki
T
T
Klinika Chorób Serca i Naczyń, Instytutu Kardiologii, Collegium Medicum, Uniwersytetu Jagielońskiego w Krakowie.
Pieniazek
P
P
Tracz
W
W
Ryniewicz
W
W
Olszowska
M
M
Kostkiewicz
M
M
Podolec
P
P
Pasowicz
M
M
Sokołowski
A
A
D000367:Age Factors; D000368:Aged; D000800:Angioplasty, Balloon / Q000379:methods*; D003327:Coronary Disease / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome