TRANSLUMINAL CORONARY ANGIOPLASTY PATIENTS OVER 70 YEARS OF AGE - MULTIVARIATE-ANALYSIS OF THE FACTORS INFLUENCING IMMEDIATE RESULTS AND LONG-TERM PROGNOSIS

Between January 1986 and July 1990, 186 patients over 70 years of age underwent 215 transluminal coronary angioplasties. The patients' chara cteristics were : 117 men and 69 women ; mean age 75.5 +/- 4 years (70 -89 years) : left ventricular ejection fraction 62 +/- 12 % : 40 % had previous myocardial infarction ; 48 % had single vessel disease ; 80% had severe angina (19 % Class III and 61 % Class IV) and 58 % of dila ted vessels had calcification. In all, 276 vessels (1.3 patient) were dilated : one vessel in 77 %, 2 vessels in 18 % and 3 or more in 5 % o f patients. The primary success rate defined as a reduction of the dia meter of stenosis below 50 % was 81 % (174/215 procedures) (85 % - 215 /253 stenosis-in dilatations and 65 % - 15/23 obstructions - in attemp ted disobliterations). There were 4 deaths (2.1 %), 12 Q wave infarcts (5.5 %) and 5 non Q wave infarcts (2.3 %), 2 emergency bypass grafts procedures and no cerebrovascular accidents. A multivariate analysis i dentified two factors which reduced the primary success rate: coronary calcification (p < 0.02) and a history of previous infarction (p < 0. 02). Three factors were associated with an increased risk of periopera tive infarction : the female sex, age > 75 years (p < 0.01) and previo us infarction (p < 0.03). The first 154 patients were followed up for 25 +/- 14 months (8-61 months) without any patients being lost to foll ow-up. In this period, 16 patients died (11 of cardiac causes), 2 had non-fatal infarction, 13 underwent secondary aortocoronary bypass surg ery and 30 patients (20 %) developed an angiographic restenosis. The l ong term survival (Kaplan-Meier) was 85 +/- 6 % at 5 years (91 % in ca ses of successful angioplasty and 73 % in cases of failure, p < 0.001) . In the 134 survivors, 76 % have no angina, 97 % are in NYHA Stages I or II and 94 % continue to receive antianginal drugs. This study show s that angioplasty can be performed in patients over 70 years of age w ith good results and an acceptable rate of complications. The results are not so good when the arteries are very calcified, when there has b een previous infarction and in women. Finally, when angioplasty is suc cessful, the long-term outcome is good.