title: High prevalence of severe coronary artery disease in elderly patients with non-operable chronic thromboembolic pulmonary hypertension referred for balloon pulmonary angioplasty.
abstract: BACKGROUND
  Balloon pulmonary angioplasty (BPA) is a new emerging catheter-based alternative treatment option for patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH).
  
  
  OBJECTIVE
  To show that all elderly CTEPH patients referred for BPA are at higher risk of obstructive coronary artery disease and that, in daily practice, they should undergo invasive coronary angiography.
  
  
  METHODS
  Eleven patients at the age of at least 65 years (6 males, 5 females, 77.2 ±5.9 years) with confirmed non-operable type II or type III CTEPH, considered for BPA, underwent elective coronary angiography. Severe obstructive coronary artery disease (CAD) was diagnosed when stenosis of left main coronary artery ≥ 50% or stenosis of ≥ 70% of epicardial arteries was angiographically confirmed. We also screened for CAD consecutive age- and sex-matched 114 PE survivors (52 males, 62 females, 74.8 ±7.2 years) with excluded CTEPH.
  
  
  RESULTS
  Severe CAD was more frequent in elderly patients with non-operable type II or type III CTEPH candidates for BPA than in elderly acute PE survivors with excluded CTEPH (54.5% vs. 16.7%,p< 0.01), and therefore elderly CTEPH patients referred for BPA were at higher risk of CAD (OR = 5.9, 95% CI: 1.64-21.46,p= 0.007) when compared to elderly survivors after acute PE with excluded CTEPH.
  
  
  CONCLUSIONS
  All elderly CTEPH patients referred for BPA are at higher risk of severe CAD and should routinely undergo invasive coronary angiography before BPA.
authors.affiliation: Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Marek
authors.initials: M
authors.lastname: Roik
authors.affiliation: Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Dominik
authors.initials: D
authors.lastname: Wretowski
authors.affiliation: Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Maciej
authors.initials: M
authors.lastname: Kostrubiec
authors.affiliation: Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Olga
authors.initials: O
authors.lastname: Dzikowska-Diduch
authors.affiliation: Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Łabyk
authors.affiliation: Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Irzyk
authors.affiliation: Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Barbara
authors.initials: B
authors.lastname: Lichodziejewska
authors.affiliation: Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Anna
authors.initials: A
authors.lastname: Wyzgał
authors.affiliation: Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Jankowski
authors.affiliation: Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Pruszczyk
keywords: balloon pulmonary angioplasty; chronic thromboembolic pulmonary hypertension; invasive coronary angiography; obstructive coronary artery disease