MYOCARDIAL REVASCULARIZATION IN GERIATRIC -PATIENTS

The results of percutaneous transluminal coronary angioplasty (PTCA) i n 71 patients over 75 years of age were retrospectively analyzed and c ompared with those of 55 patients aged over 75 who underwent surgical revascularization (CABG) during the same time period (1992-1995). The main indication for revascularization was unstable angina. The clinica l success in PTCA patients was 92% with a lesion success rate of 93%. Major cardiac complications occurred in 5% of patients with am in-hosp ital mortality of 1%. The mean hospital stay was 4 days. During a foll ow-up period of 16 (range 1-36) months, 23% of patients treated with P TCA needed repeat revascularization (17% PTCA, 6% CABG) and 4 patients (6%) suffered nonfatal myocardial infarction. In-hospital mortality a nd complications were higher among the surgically treated patients (mo rtality 7%, major complications 45%), a fact probably related to their poorer clinical condition preoperatively. Repeat revascularization ra te in the surgically treated group was 2% . The long-term mortality ra te in both groups was 10%. Among long-term survivors , 92% of patients indicated that revascularization (PTCA or CABG) improved their qualit y of life. More than 80% led normal lives, and >90% would undergo a se cond procedure if needed. In selected patients aged over 75, PTCA has a high immediate success rate with low complications and mortality. Lo ng-term recurrence rate is high, however, and repeat revascularization s are frequent. Patients satisfaction after myocardial revascularizati on (PTCA or CABG) is excellent and the majority of elderly patients ca n lead an active and independent life.