CORONARY-ARTERY STENTING IN THE ELDERLY - SHORT-TERM OUTCOME AND LONG-TERM ANGIOGRAPHIC AND CLINICAL FOLLOW-UP

Objectives. This study sought to compare the short- and longterm outco mes of elderly patients undergoing coronary artery stenting with those of younger patients and to determine the long-term clinical outcome a nd survival of elderly patients post stent implantation. Background. E lderly patients undergoing coronary revascularization are considered a high-risk group. Few data exist that relate the results of stenting i n treating coronary artery disease in the elderly population. Methods. All elderly patients greater than or equal to 75 years of age who und erwent coronary artery stenting between March 1993 and July 1997 (n = 137) at our center were compared to the patients <75 who underwent cor onary artery stenting during the same time period (n = 2,551). Long-te rm clinical follow-up and survival were determined for the elderly gro up. Results. Elderly patients presented,vith lower ejection fractions (54% vs. 58%, p = 0.0001), more unstable angina (47% vs. 28%, p = 0.00 01), and more multivessel disease (78% vs. 62%, p = 0.0001) than young er patients. These older patients had higher rates of procedure relate d complications including procedural myocardial infarction (MI) (2.9% vs. 1.7%, p = 0.2), emergency CABG (3.7% vs. 1.4%, p = 0.04), and deat h (2.2% vs. 0.12%, p = 0.0001). Angiographic follow-up, obtained in bo th groups, demonstrated significantly higher restenosis rates in the e lderly versus younger patients (47% vs. 28%, p = 0.0007). Longer term clinical follow-up, which was obtained only in the elderly group, show ed that at a mean follow-up period of 12 months post coronary stenting , elderly survival free from death, MZ, revascularization and angina w as 54% and that their overall survival was 91%. Subanalysis of the eld erly patients who died showed much higher incidence of combined unstab le angina (80%), prior MI (60%), lower ejection fraction (46%), multiv essel disease (100%) and complex lesions (100%) than the overall group . Conclusions. Elderly patients who undergo coronary artery stenting h ave significantly higher rates of procedural complications and worse s ix month outcomes than younger patients, especially those who present with combined unstable angina, history of MI, EF < 50%, multivessel di sease and complex lesions. Overall survival in the elderly population at 12 months postcoronary artery stenting was 91% and event-free survi val was 54%. (J Am Coil Cardiol 1998;32:577-83) (C) 1998 by the Americ an College of Cardiology.