Angioplasty in octogenarians - Tips from Other Journals

Date: Dec, 1990

Percutaneous transluminal coronary angioplasty has proved to be safe and effective in the treatment of coronary artery disease. Jeroudi and colleagues assessed the safety of this procedure in octogenarians.

The authors reviewed the medical records of 54 consecutive patients over age 80 (mean age: 82.4 years) who underwent percutaneous transluminal coronary angioplasty. Of these patients, 31 percent had stable angina and 59 percent had unstable angina. Twenty-six patients (48 percent) had previous myocardial infarction, and 15 (28 percent) had previously undergone coronary artery bypass surgery. Multivessel disease was present in 44 patients (81 percent). Follow-up ranged from two months to four years and two months (mean: two years and seven months).

Angioplasty was successful in 50 (93 percent) of the 54 patients, and clinical success was achieved in 49 patients (91 percent). Major complications occurred in four patients: three patients had myocardial infarction and one developed cardiac tamponade. Two patients died in the hospital, one of cardiac tamponade due to pacemaker perforation and one of cardiogenic shock due to myocardial infarction.

During follow-up, four patients required bypass surgery, and all four survived. Two patients had myocardial infarction and died. In all, seven died (four deaths were from cardiac causes). Eleven patients had restenosis, and seven of these patients underwent repeat angioplasty. One patient had a total of four procedures. Forty-two of the surviving 45 patients were asymptomatic or had class II angina. Eighty-one percent were free from major cardiac events (death, myocardial infarction or coronary bypass surgery) at one year, and 78 percent were free of disease at three years. The authors conclude that percutaneous transluminal coronary angioplasty is associated with a high rate of success and a low rate of complications in octogenarians. (Annals of Internal Medicine, September 15, 1990, vol. 113, p. 423.)

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