"Do least harm" philosophy may suffice for percutaneous coronary intervention in octogenarians.
BACKGROUND
Octogenarians represent one of the most rapidly expanding segments of the population and an ever growing number are undergoing percutaneous coronary intervention (PCI). A simplified approach with incomplete or "culprit-lesion" only PCI may be an option even in multivessel disease, to minimize periprocedural complications while still allowing a meaningful clinical recovery in patients with inherent functional limitations related to age itself. We tried to determine the effects of either complete or partial PCI on procedural and long-term outcome in a consecutive series of octogenarians.


METHODS
In-hospital and 1-year clinical outcomes were collected in elderly patients treated with PCI between January 1998 and March 2004 in our institution.


RESULTS
In a total of 165 octogenarians, 73 elderly patients (44%) underwent complete (COM) and 92 (56%) incomplete (INC) revascularization. Major in-hospital cardiac events were similar in the two subgroups. At 1-year follow-up 65% of patients in the COM and 68% in the INC group (P = ns) referred improvement in angina status and quality of life. Clinically driven repeat PCI was necessary in 16% of COM and 15% of INC patients. Recurrent PCI was mostly required to treat a restenotic index lesion in both groups, while only five patients in the INC group (5.4%) required PCI of a different lesion.


CONCLUSIONS
Current PCI coronary techniques are safe and effective in octogenarians. Restenosis remains the main cause for recurrent events after bare metal stents. Percutaneous revascularization limited to the culprit lesion may suffice in most patients, with favorable clinical outcome at 1 year.
Rossi
Marco L
ML
Division of Cardiology, Unità Operativa di Emodinamica e Cardiologia Invasiva, Istituto Clinico Humanitas, Milan, Italy. marcolrossi@hotmail.com
Belli
Guido
G
Parenti
Dennis Zavalloni
DZ
Scatturin
Melania
M
Pagnotta
Paolo
P
Gasparini
Gabriele
G
Presbitero
Patrizia
P
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary; D003324:Coronary Artery Disease / Q000401:mortality / Q000628:therapy*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D012107:Research Design; D013997:Time Factors; D016896:Treatment Outcome