DIAGNOSTIC AND THERAPEUTIC STRATEGY IN CO RONARY INSUFFICIENCY OF ELDERLY PATIENTS - RESULTS IN 65 CASES

As people live longer, so cardiologists are having to manage coronary artery disease in progressively older patients with more severe corona ry lesions. The authors tried to determine the feasability and results of coronary angiography in a retrospective study of 65 patients (44 m en and 21 women) over 75 years of age (range 75 to 84 years) with coro nary artery disease (excluding valvular heart disease). The study peri od was 22 months. The commonest indication was unstable or invalidatin g angina resistant to medical therapy (42 of the 65 cases). Twenty-two patients underwent coronary angiography in the context of myocardial infarction complicated in 3 cases by septal rupture. With the exceptio n of these 3 patients, two of whom underwent surgery, 39 of the 62 rem aining patients were judged to be candidates for myocardial revascular isation (63 %); 37 underwent a revascularisation procedure (60 %), 20 by percutaneous transluminal coronary angioplasty and 17 by coronary b ypass surgery. The primary success rate of angioplasty was 90 % (18 ou t of 20). There were no deaths in this group. Two patients who were re ferred for surgery died, an operative mortality of 12 % (2 out of 17). All patients were followed up: 56 out of the 65 were still alive at t he time of enquiry, after an average period of 18 months. All survivin g patients who were successfully revascularised (by angioplasty or sur gery) were pauci- or asymptomatic. Although there is an increased mort ality related to revascularisation of elderly patients, this would see m to be acceptable given the quality of die medium term clinical resul ts.