PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY IN PATIENTS 70 YEARS OF AGE OR OLDER - 12 YEARS EXPERIENCE

Objective-To evaluate the short and long term results of coronary angi oplasty in patients aged 70 years and older and identify the determina nts of long-term survival. Design-A retrospective analysis of clinical , angiographic, and procedure related variables on a consecutive serie s of patients. Patients-163 patients aged 70 years and older (mean (ra nge) age 73 (70-83) years; 63% men) who underwent a first coronary ang ioplasty procedure between 1981 and 1993. Results-Procedural success a chieved in 82% of patients. patients (2%) died, three (2%) infarction, and five emergency coronary artery bypass surgery. Complete follow up data were available for all patients (median (range) 35 (2-146) month s). During the follow up period 16 patients (10%) died, two (1%) suffe red non-fatal myocardial infarction, and 12 (7%) underwent elective co ronary artery bypass surgery. A second angioplasty procedure was perfo rmed in 24 patients (15%). The cumulative probability of survival was 90.7% at 1 year and 83.4% at 5 years. Survival free from myocardial in farction, bypass surgery, and repeat angioplasty at 1 and 5 years was 68.2% and 56.0%, respectively. Proportional hazards regression analyse s identified incomplete revascularisation as the only independent pred ictor of poorer overall survival (P = 0.04) and event free survival (P < 0.001). At census, of the 143 survivors, 75 (52%) were asymptomatic , 58 (41%) had mild angina, and only 10 (7%) complained of grade III o r IV angina. Some 112 patients (78%) improved by at least two angina g rades. Conclusion-Coronary angioplasty can be performed safely in the elderly and treated provides good symptomatic relief and favourable lo ng-term outcome. Complete revascularisation may not be necessary if th e primary goal is to achieve symptomatic relief, but incomplete revasc ularisation is associated with poorer long-term survival.