CORONARY ANGIOGRAPHY IN OCTOGENARIANS - RESULTS AND IMPLICATIONS FOR REVASCULARIZATION

PURPOSE: To determine the risks and the consequences of coronary angio graphy performed on octogenarians with symptomatic coronary artery dis ease. PATIENTS AND METHODS: In order to define angiographic findings, procedural complications, and therapeutic consequences, a retrospectiv e evaluation was made of 115 consecutive patients with angina, aged 80 or above, who underwent coronary angiography in our institution betwe en 1988 and 1992. RESULTS: In all, 115 patients (68 men) aged 82 +/- 2 years, 70% with unstable angina, underwent coronary angiography corre sponding to 1.4% of all the procedures performed between 1988 and 1992 . Three-vessel or left main coronary artery disease, or both, was foun d in 42% of cases, but this proportion decreased over the years. Revas cularization by means of percutaneous transluminal angioplasty (PTCA) or bypass grafting followed angiography in 54% of cases. Use of revasc ularization has markedly increased, from 33% in 1988 to 64% in 1992 (P <0.05), and now tends to be performed more often by PTCA. Eight patie nts (7%) suffered minor periprocedural complications and 8 patients (7 %) died in the hospital, but none of the deaths was directly related t o the diagnostic procedure itself. At follow-up (28 +/- 16 months), 68 % and 44% of the survivors were free of angina after revascularization and medical treatment, respectively (P <0.05), and there was a nonsig nificant trend for better survival after revascularization. Of the sur vivors, 80% were able to pursue an independent life. CONCLUSIONS: Coro nary angiography may be done in symptomatic octogenarians with an acce ptably low complication rate. Following diagnostic evaluation, revascu larization procedures are performed in an increasing proportion of pat ients, and despite a relatively high procedural complication rate, the y result in definite symptomatic improvement.