Changing outcome of angioplasty in the elderly

• Published in: Journal of the American College of Cardiology Vol. 27; no. 1; pp. 8 - 14
• Main Authors: Thompson, Randall C., Holmes, David R., Grill, Diane E., Mock, Michael B., Bailey, Kent R.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.01.1996; Elsevier Science
• Subjects: Aged; Aged, 80 and over; Analysis of Variance; Angina, Unstable - epidemiology; Angina, Unstable - etiology; Angioplasty, Balloon, Coronary - adverse effects; Angioplasty, Balloon, Coronary - mortality; Angioplasty, Balloon, Coronary - trends; Arrhythmias, Cardiac - epidemiology; Arrhythmias, Cardiac - etiology; Biological and medical sciences; Coronary Artery Bypass; Disease-Free Survival; Diseases of the cardiovascular system; Female; Follow-Up Studies; Humans; Incidence; Logistic Models; Male; Medical sciences; Myocardial Infarction - epidemiology; Myocardial Infarction - etiology; Outcome Assessment (Health Care); Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Recurrence; Risk Factors; Human; Treatment; Follow up study; Coronary artery; Instrumentation therapy; Instrumental dilatation; Survival; Elderly; Age
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/0735-1097(95)00436-X

This study sought to determine whether in-hospital and intermediate-term posthospital outcomes have changed in elderly patients undergoing percutaneous transluminal coronary angioplasty from the period 1980 through 1989 to the period 1990 through 1992. Although elderly patients have a higher incidence of procedure-related deaths and late recurrence of angina after coronary angioplasty, recent complication rates for angioplasty seem to be lower. From 1980 to 1989, 982 patients ≥65 years old underwent nonemergent coronary angioplasty (group A). They were compared with 768 similar patients who had coronary angioplasty from 1990 to 1992 (group B). Patients in group B were older than those in group A and had a higher mean concomitant disease score, a higher proportion of men and a greater proportion of patients with a previous myocardial infarction and previous coronary artery bypass surgery. Despite the increased complexity of the group B cohort, procedural success rates were higher, and rates of important in-hospital complications were much lower than those in group A. For group A versus group B, respectively, the technical success rate was 88.1% versus 93.5% (p < 0.001), in-hospital death rate 3.3% versus 1.4% (p = 0.014), emergency bypass surgery rate 5.5% versus 0.65% (p < 0.001) and incidence of in-hospital death or myocardial infarction 6.3% versus 3.4% (p < 0.005). However, intermediate-term posthospital event-free rates in hospital survivors did not decrease. The rate of death or myocardial infarction at 6 months was 4.7% in group A versus 7.1% in group B (p < 0.05). Survival free of acute myocardial infarction, bypass surgery, repeat coronary angioplasty or severe angina at 1 year was 66.7% in group A versus 54.9% in group B (p < 0.001). The combined in-hospital death/myocardial infarction rate plus that for the first 6 months after hospital dismissal was essentially equivalent for the two groups (10.3% vs. 9.9%, p = NS). An increase in technical success rates and a reduction in short-term complication rates for coronary angioplasty in the elderly in recent years have not translated into an improved event-free survival rate, which continues to be influenced by important baseline characteristics of these high risk patients.