Unstable angina in octogenarians: Is an invasive approach feasible and effective?

Background and objective. Octogenarian patients with unstable angina are us ually managed more conservatively despite having a worse prognosis. Studies of balloon angioplasty in the elderly have demonstrated a higher incidence of adverse events but the new advances (mainly stenting) have improved the results. We evaluated the efficacy and safety of an invasive approach in o ctogenarians with unstable angina. Patients and method. From January 1996 to October 1999, 100 patients at lea st 80 years old with unstable angina were admitted to our unit and among th ese, 74 (74%) underwent percutaneous revascularization. We evaluated immedi ate results, in-hospital events and clinical follow-up. Results. A total of 145 lesions were treated in 74 patients. The stent impl antation rate was 79%. The success rate was 92%. Two patients died during h ospitalization due to cardiac causes and 1 patient had a non-Q infarction. At follow-up, 24 +/- 12 months (range: 4 -50 months) 14 patients died (19.4 %). New revascularization was performed in 10 patients (13.5%), 9 with PTCA and 1 with surgery. The survival rate free of death and infarction in the first year was 89.2%. At the end of follow-up 58 patients were alive (78.4% ), 45 asymptomatic and 13 had stable angina, class I or II. Conclusions. The results of stent implantation in octogenarians were good w ith a 92% procedural success. Ninety-six percent of patients were free of d eath and infarction during hospitalization and 78.4% of the patients remain ned alive, most of them asymptomatic at the end of follow-up.