Percutaneous transluminal coronary angioplasty in the elderly: Epidemiology, clinical risk factors, and in-hospital outcomes

Objectives To explore the relation between older age and clinical presentat ion, procedural success, and in-hospital outcomes among a large unselected population undergoing percutaneous transluminal coronary angioplasty (PTCA) . Background Although more elderly patients are receiving PTCA, studies of po st PTCA outcomes among the elderly have been limited by small numbers and e xclusive selection criteria. Methods Data were collected as a part of a prospective registry of all perc utaneous coronary interventions performed in Maine, New Hampshire, and from 1 institution in Massachusetts between October 1989 and December 1993. Com parisons across 4 age groups, (<60, 60 to 69, 70 to 79, and 80 years and ab ove) were performed using chi-square tests, the Mantel-Haenzsel test for tr end, and logistic regression. Results Twelve thousand one hundred seventy-two hospitalizations for PTCA w ere performed with 507 of them (4%) in persons at least 80 years old. Octog enarians were more likely to be women, have multivessel disease, high-grade stenoses, and complex lesions but were less likely to have hypercholestero lemia, a history of smoking, or have undergone a previous PTCA. In the elde rly, PTCAs were more often performed urgently and for unstable syndromes co mpared with younger age groups. Advancing age is strongly associated with i n-hospital death, and among the oldest old with an increased risk of postpr ocedural myocardial infarction. Despite differing presentation and procedur al priority, angiographic success and subsequent bypass surgery did not var y by age. Conclusions With the increasing age of the population at large as well as t hat segment at risk for cardiac revascularization, information about age-as sociated risks of the procedure, especially the substantially higher risk o f death in octogenarians, will be critical for both physicians and patients considering PTCA.