[Coronary stent implantation in elderly patients: acute and long-term results].
The number of elderly patients with coronary heart disease is rapidly growing. Morbidity, related with PTCA is increased in elderly patients, presumably because of the more complex adverse baseline characteristics. However, it has not been firmly elucidated whether routine use of coronary stents is associated with a more favourable outcome in this population. Therefore, we investigated the influence of age on acute procedural success, rate of restenosis (quantitative coronary angiography) and major cardiovascular events (death/myocardial infarction [MI]) 6 months after intra-coronary stent implantation in 1306 patients. Patients were categorised into < 65 years (n = 709),65-75 years (n = 443) and >75 years (n= 154).


RESULTS
Older patients had a higher amount of multivessel disease (p < 0.001) and a lower left ventricular ejection fraction (p < 0.001). Nevertheless, the rate of acute success and restenosis were comparable between the different age groups. In contrast, older patients had significantly more adverse clinical events during long-term followup. (Death/MI < 65 years 3.0%, 65-75 years 3.9%, > 75 years 7.8%, p = 0.02). However, by multivariate analysis age was no longer an independent predictor of adverse clinical events (p = 0.26), which were predominantly determined by coexisting impaired left ventricular function (p < 0.001).


CONCLUSIONS
After proper judgement of the clinical situation, coronary stent implantation should be considered in selected elderly patients. Thus, advanced age as a solely factor should not be regarded as a contraindication for coronary stent implantation.
Assmus
B
B
Medizinische Klinik IV, Abteilung für Kardiologie/Nephrologie, J.W.-Goethe-Universität, Theodor-Stern-Kai 7, 60590 Frankfurt/Main, Germany.
Walter
D H
DH
Britten
M B
MB
Fichtlscherer
S
S
Auch-Schwelk
W
W
Zeiher
A M
AM
Schächinger
V
V
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000401:mortality; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000175:diagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000209:etiology; D015607:Stents / Q000009:adverse effects; D013318:Stroke Volume; D016019:Survival Analysis; D013997:Time Factors
Koronare Stentimplantation bei alten Patienten. Akutergebnisse und Langzeitverlauf.