ONE-MONTH RESULTS OF CORONARY STENTING IN PATIENTS GREATER-THAN-OR-EQUAL-TO-75 YEARS OF AGE

Coronary artery bypass operations are associated with increased morbid ity and mortality in the elderly. Similarly, it has been shown that co ronary angioplasty is associated with a higher risk of complications i n the elderly than in younger patients. The purpose of this study was to evaluate the 1-month outcome of elderly patients (>75 years old) wh o were included in the Stenting without Coumadin French Registry. From December 1992 to March 1995, 2,900 patients (mean age 61 +/- 11 years ) were included in this registry. All patients were treated with ticlo pidine (250 to 500 mg/day) for 1 month from the day of percutaneous tr ansluminal angioplasty, aspirin (100 to 250 mg/day) for >6 months, and low-molecular-weight heparin (antiXa 0.5 to 1 IU/ml) for 1 month in p hase II, 15 days in phase III, and 7 days in phase IV. No heparin was given in phase V. The study group included 233 patients (8.0%) >75 yea rs old (mean age 79 +/- 4), 44 (18%) of whom were women. All patients underwent dilatation of a native coronary vessel. One hundred seventee n had unstable angina (50.2%), 20 had postmyocardial infarction ischem ia (8.6%), and 6 had acute myocardial infarction (2.6%). Indications f or stenting were de nova lesion in 63 patients (27.0%), restenosis in 38 (16.3%), suboptimal result in 48 (20.6%), nonocclusive dissection i n 56 (24.0%), and occlusive dissection in 28 (12.0%), respectively. St ented coronary arteries were the left anterior descending in 109 (46.8 %), the right in 80 (34.3%), the left circumflex in 40 (17.2%), and th e left main in 4 (1.7%). Palmaz-Schatz stents were used in 228 patient s (82.0%), AVE microstents in 38 (13.7%), and other stents in 12 (4.3% ). More than 1 stent was used in 48 patients (17.3%). The mean diamete r of the balloon used for stenting was 3.31 +/- 0.38 mm and maximal in flation pressure was 12.2 +/- 2.9 atm. At one-month follow-up, vascula r complications occurred in 5 patients, requiring surgery in 2 (1.3%), acute closure occurred in 1 (0.4%), subacute closure in 3 (1.3%), eme rgency or planned coronary artery bypass graft surgery in none, acute myocardial infarction in 4 (1.7%), stroke in 1 (0.4%), and death in 8 (3.4%). The composite end point of a major cardiac event was observed in 13 cases (5.6%). Coronary stenting using ticlopidine and aspirin ap pears to be a particularly safe approach in this high-risk subset. (C) 1998 by Excerpta Medica, Inc.