RESULTS OF DIRECT PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY IN OCTOGENARIANS

Direct percutaneous transluminal coronary angioplasty (PTCA) has emerg ed as effective reperfusion therapy for acute myocardial infarction; h owever, few data exist on its use in octogenarians, Thrombolytic thera py in this age group has reduced early mortality from approximately 30 % to 20%, but is associated with an increased risk of stroke and major hemorrhage. We analyzed the acute and long-term results of direct PTC A performed on patients aged greater than or equal to 80 years at our institution between 1980 and 1993, The study group consisted of 55 pat ients (mean patient age 83.3 +/- 2.3 years), Infarcts were anterior in 27 patients (49%), Cardiogenic shock was present in 6 patients (11%), The mean time to reperfusion was 4.3 +/- 2.8 hours, Direct PTCA was s uccessful in 53 patients (96%). There were no emergent bypass operatio ns. In-hospital death occurred in 9 patients (16%), including 4 of 6 ( 67%) presenting in cardiogenic shock and 5 of 49 (10%) who were hemody namically stable on presentation, Repeat PTCA for recurrent ischemia w as performed in 6 patients (11%), There were no strokes during hospita lization, Bleeding complications requiring blood transfusion were pres ent in 4 patients (7%). Thirty-day mortality was 16% and 1-year actuar ial survival was 67%. Direct PTCA in patients aged greater than or equ al to 80 years can be performed safely with a high procedural success rate. The clinical outcome with PTCA in this high risk subset of patie nts compares favorably with that reported previously for both thrombol ytic and medical therapy.