CORONARY STENTING IN OCTOGENARIANS FOLLOWING FAILED BALLOON ANGIOPLASTY

Background Balloon dilatation of the coronary arteries [percutaneous t ransluminal coronary angioplasty (PTCA)] is increasingly used in the e lderly population, thus increasing the potential need for coronary ste nt implantation in this group. We report on the feasibility and safety of coronary stenting for failed PTCA in selected octogenarians. Metho ds Between November 1991 and June 1995, we performed PTCA in 108 patie nts aged 80 years or more (mean age 82 years). Eighteen patients with a poor PTCA outcome required the implantation of 28 Palmaz-Schatz sten ts. The stented artery was the left main (n = 2), left anterior descen ding (n = 10), right (n = 5), or circumflex coronary artery (n = 1), E leven procedures were for suboptimal angiographic result and seven wer e rescue interventions. Eight patients (44%) had additional PTCA perfo rmed in another Vessel during the same procedure. Results All of the p rocedures were technically successful. There were two target-vessel oc clusions (11%) on day 2, one of which was reversed by repeat PTCA. Maj or complications occurred in two patients (11%) during their stay in h ospital: one bleeding-related death and one Q-wave myocardial infarct. There was no need for emergency coronary artery bypass grafting. Afte r a mean follow-up of 8 +/- 8 months, one patient had died of progress ive cardiac failure, 12 were free of angina and four had New York Hear t Association class II angina, Three patients needed repeat PTCA. Ther e was no late acute myocardial infarction and no need for coronary art ery bypass grafting. Conclusions Coronary stenting for failed PTCA in octogenarians appears to be an effective procedure and is associated w ith a complication rate similar to that observed in younger patients.