LONG-TERM MEDICAL-CARE AFTER MULTIVESSEL PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY IN OLDER PATIENTS - COMPARISON WITH YOUNGER SUBJECTS

Background Percutaneous transluminal coronary angioplasty (PTCA) is le ss invasive than coronary artery bypass grafting (CABG). The technique should therefore be more suitable than CABG for elderly patients with diffuse, severe coronary artery disease that is hard to manage with m edical therapy. However, few studies have examined the outcome of mult ivessel angioplasty in older patients. Method Multivessel PTCA, define d as PTCA of two or three of the major coronary arteries, was performe d in 203 selected patients from 1981 to 1986. Patients aged 65 years o r more (n = 21, group I) were compared with the younger patients (n = 182, group II), The number of segments with greater than 50% stenosis was higher in group I (3 +/- 1 versus 2.6 +/- 0.7 in group II, P < 0.0 1). Complete revascularization by PTCA of all stenoses greater than 50 % was attempted, with 2.4 +/- 0.9 successful dilated segments per pati ent in group I versus 2.1 +/- 0.7 in group II (P = 0.09). Results Acut e complications (myocardial infarction or urgent bypass surgery or bot h) occurred in two patients in group I and in 1 1 patients in group II (NS). Mean follow-up was 72 +/- 21 months in group I acid 71 +/- 23 m onths in group II (NS). Medical care, rate of repeat revascularization , cardiac events and clinical status during the follow-up were identic al in both groups. Cardiac survival without myocardial infarction was 87% in group I and 85% in group II, At the end of follow-up, 85% and 8 4% respectively of patients in groups I and II were asymptomatic or in grade 1 of the Canadian Cardiovascular Society classification. Conclu sion Multivessel PTCA in selected patients aged 65 years or more carri es a similar favorable long-term outcome to that in the younger popula tion. The procedure should be considered as a therapeutic alternative to surgery in this group of high-risk patients.