Mohamed O. Jeroudi, MD; Neal S. Kleiman, MD; Steven T. Minor, MD; Kenneth R. Hess, MS; John M. Lewis, MD; William L. Winters Jr., MD; Albert E. Raizner, MD
Objective: To assess the safety and short- and long-term outcomes of percutaneous transluminal coronary angioplasty in octogenarians.
Design: Retrospective chart review of clinical series.
Setting: Referral-based university medical center.
Patients: Consecutive series of 54 octogenarian patients (mean age, 82.4 years) who had percutaneous transluminal coronary angioplasty between March 1980 and December 1988. Of these patients, 91% presented with severe angina (Canadian Cardiovascular Society Class III or IV); 59% had unstable angina. Twenty-six patients (48%) had had a previous myocardial infarction and 15 (28%) had had previous coronary artery bypass surgery. Multivessel disease was present in 44 patients (81%). Follow-up ranged from 1 to 50 months (mean, 19 months).
Intervention: Percutaneous transluminal coronary angioplasty.
Measurements and Main Results: The angiographic success rate was 50 of 54 (93%; 95% CI, 81% to 98%) and the clinical success rate was 49 of 54 (91%; CI, 79% to 97%). Two patients had procedure-related myocardial infarction. Two patients died in the hospital, 1 from cardiac tamponade because of pacemaker perforation and 1 from cardiogenic shock after a myocardial infarction despite successful angioplasty. During the follow-up period 4 patients required bypass surgery, 2 had myocardial infarction, and 7 died (4 deaths were cardiac). Eleven patients (20%) had restenosis, 7 of whom were managed with repeat angioplasty, including 1 patient who had four procedures. At follow-up, 42 of 45 survivors (93%) were asymptomatic or had class II angina. The Kaplan-Meier survival for all patients, including those who died in the hospital, was 87% at 1 year and 80% at 3 years. Cumulative freedom from major cardiac events (death, myocardial infarction, or coronary bypass surgery) was 81% at 1 year and 78% at 3 years.
Conclusions: Percutaneous transluminal coronary angioplasty can be done in octogenarians with a high rate of angiographic and clinical success, low complication rate, and a favorable long-term (3-year) outcome. As such, it is a treatment option in managing advanced coronary artery disease in this fragile group of patients.
Mohamed O. Jeroudi, Neal S. Kleiman, Steven T. Minor, Kenneth R. Hess, John M. Lewis, William L. Winters, et al. Percutaneous Transluminal Coronary Angioplasty in Octogenarians. Ann Intern Med. 1990;113:423–428. doi: 10.7326/0003-4819-113-6-423
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Published: Ann Intern Med. 1990;113(6):423-428.
Cardiology, Coronary Heart Disease, Percutaneous Coronary Intervention.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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