CORONARY REVASCULARIZATION AFTER MYOCARDIAL-INFARCTION IN THE VERY ELDERLY - OUTCOMES AND LONG-TERM FOLLOW-UP

Objective: To determine the outcome of very elderly patients who had c oronary revascularization during hospitalization for an acute myocardi al infarction. Design: Retrospective cohort study. Setting: Community- based tertiary-care teaching hospital. Patients: A total of 1215 conse cutive patients 80 years and older were hospitalized with a myocardial infarction between 1985 and 1990. The study sample included all 93 pa tients (8%) who had cardiac catheterization before discharge and had n ot been excluded from study because of the following: severe valvular disease, absence of significant coronary disease, or death before a de cision about revascularization could be made. Measurements: Survival, quality of life, and functional status at least 1 year after discharge . Results: After catheterization, 41 patients had angioplasty, 18 had coronary artery bypass surgery, and 34 did not have revascularization. Among the patients alive at discharge, those who had revascularizatio n had a high likelihood of achieving a good or excellent quality of li fe (angioplasty, 86% [31 of 36]; surgery, 89% [16 of 18]; medical ther apy, 44% [11 of 25]) and of being able to care for themselves (angiopl asty, 89% [32 of 36], surgery, 89% [16 of 18], medical therapy, 52% [1 3 of 25]). Mortality rates at 1 year were 24% (95% CI, 15% to 47%) for the angioplasty group, 6% (CI, 0% to 27%) for the surgery group, and 44% (CI, 27% to 62%) for the medical therapy group. In a Cox proportio nal hazards model that adjusted for clinical, demographic, hemodynamic , and anatomic differences between the groups, the performance of coro nary revascularization was associated with increased survival (hazard ratio, 0.42; CI, 0.18 to 0.98). Conclusions: A small percentage of ver y elderly patients with complicated acute myocardial infarctions, sele cted by their physicians for invasive cardiovascular procedures, can t olerate these procedures, avoid serious complications, return to indep endent living, and have excellent probability of survival. Although ou r results suggest that coronary revascularization may have benefited t hese patients, the study design did not permit definite conclusions, a nd future studies are needed to resolve this important question.