Is coronary angioplasty safe in the elderly?

OBJECTIVE: To evaluate the use of percutaneous transluminal coronary angiop lasty (PTCA) and the immediate procedural outcomes in the elderly at a tert iary care centre, PATIENTS AND METHODS: Between January 1992 and December 1997, a total retro spective cohort study of 2322 consecutive patients aged 60 years or older u nderwent PTCA. Patients were categorized into three age groups: group A (60 to 69 years of age), which included 1294 patients; group B (70 to 79 years ), which included 895 patients; and group C (80 years of age or older), whi ch included 133 patients. PTCA was performed using the newest catheter tech nology as it became avail able. RESULTS: Men comprised 63% of the patients in groups PI and B combined, and 44% of group C (P<0.001). Canadian Cardiovascular Society angina class IV was present in 45% of group C compared with 30% and 35% in groups A and B, respectively (P<0.001). The proportion of patients with diabetes mellitus a nd hypertension was similar among the three groups. Acute myocardial infarc tion before PTCA was twice as common at 4.5% (95% CI 3.7% to 5.3%) in group C, compared with 2.9% (95% CI 2.7% to 3.1%) and 2.2% (95% CI 2.0% to 2.3%) in groups A and B, respectively. The procedural success rate was similar a t 93%, 92.7% and 91.7% in groups A, B and C, respectively. A total of five (0.2%) deaths and eight (0.34%) myocardial infarctions occurred in groups A and B combined, while none occurred in group C (not significant), More pat ients in groups A and B underwent emergency coronary artery bypass graft th an in group C: group A - 22, 3.4% (95% CI 3.2% to 3.6%); group B - 16, 3.4% (95% CI 3.2% to 3.6%) and group C - one, 0.75% (95% CI 0.6% to 0.9%). CONCLUSIONS: In this retrospective series of patients, it was shown that PT CA may be performed in the very elderly with high procedural success and ac ceptable risk. Age alone should not be the criterion to limit the use of PT CA.