Address reprint requests to Jeanne Y. Wei, MD, Beth Israel Hospital, Department of Medicine, 330 Brookline Avenue, Boston, MA 02215.Search for more papers by this author

Daniel E. Forman MD,

Daniel E. Forman MD

Search for more papers by this author

Aaron D. Berman MD,

Aaron D. Berman MD

Search for more papers by this author

Carolyn H. McCabe BS,

Carolyn H. McCabe BS

Search for more papers by this author

Donald S. Baim MD,

Donald S. Baim MD

Search for more papers by this author

Jeanne Y. Wei MD, PhD,

Corresponding Author

Jeanne Y. Wei MD, PhD

Address reprint requests to Jeanne Y. Wei, MD, Beth Israel Hospital, Department of Medicine, 330 Brookline Avenue, Boston, MA 02215.Search for more papers by this author

First published: January 1992

https://doi.org/10.1111/j.1532-5415.1992.tb01823.x

Citations: 134

From the Charles A. Dana Research Institute and the Harvard-Thorndike Laboratory of Beth Israel Hospital, Department of Medicine, Beth Israel Hospital and Harvard Medical School, Geriatric Research Education and Clinical Center, West Roxbury/Brockton VA Medical Center, Boston, Massachusetts.

Presented at American Geriatrics Society Plenary Session, Atlanta, Georgia, May, 1990.

Share a link

Email
Facebook
x
LinkedIn
Reddit
Wechat

Abstract

Objective

To evaluate the use of percutaneous transluminal coronary angioplasty (PTCA) in elderly coronary artery disease (CAD) patients.

Design

A prospective study of patients 60 years and older undergoing de novo PTCA. We analyze patient risk factors, underlying disease, and clinical outcomes, with at least 3-year follow-up. Comparisons between different age strata among these patients are made to clarify differences between the young old (60 to 69 years), the middle old (70 to 79 years), and the very old (80 years and older).

Setting

Beth Israel Hospital, Boston, both a primary care and tertiary care teaching hospital.

Patients

907 consecutive elderly cardiac patients referred for PTCA are studied.

Interventions

PTCA's were completed using the newest catheter technologies as they became available. All patients were premedicated with aspirin and dipyridamole, and all were anticoagulated with heparin.

Results

Subdivision by age demonstrates that the majority (67%) of patients aged 60 to 69 were males, but females were preponderant (61%) in those aged 80 and older. Octogenarians also had lower incidence of hypercholesterolemia, tobacco use, and family history of CAD, and a higher frequency of CHF, angina, and previous MI. Although total procedure-complications increased with age, critical complications (MI, reocclusion, CABG, death) did not. Primary procedural success was similar in all age strata, but older patients had a higher prevalence of multi-vessel disease and longer hospital stay. Follow-up shows that most patients did well after PTCA; there was no increase in repeat PTCA, CABG, and MI with age.

Conclusions

While advanced age is associated with changes in risk and clinical parameters for CAD patients, age alone is not a reasonable criterion to limit the use of PTCA.

REFERENCES

1Elveback L, Lie JT. Combined high incidence of coronary artery disease at autopsy in Olmstead County, Minnesota, 1950–1979. Circulation 1984; 70: 345–349.
10.1161/01.CIR.70.3.345
CASPubMedWeb of Science®Google Scholar
2Mock MB, Fisher LD, Gersh BJ et al. Survival of older patients with coronary artery disease treated medically. Circulation 1983; 68: 413.
PubMedWeb of Science®Google Scholar
3Gersh BJ, Kronmal RA, Frye RL et al. Coronary arteriography and coronary artery bypass surgery: morbidity and mortality in patients ages 65 years or older. Circulation 1983; 67: 483–491.
10.1161/01.CIR.67.3.483
CASPubMedWeb of Science®Google Scholar
4Edmunds LH, Stephenson LW, Edie RN, Ratcliffe MB. Open-heart surgery in octogenarians. N Engl J Med 1988; 319: 131–136.
10.1056/NEJM198807213190302
PubMedWeb of Science®Google Scholar
5Naunheim KS, Kern MJ, McBride LR et al. Coronary artery bypass surgery in patients aged 80 years or older. Am J Cardiol 1987; 59: 804–807.
10.1016/0002-9149(87)91095-2
CASPubMedWeb of Science®Google Scholar
6Dorros G, Lewin RF, Daley P, Assa J. Coronary artery bypass surgery in patients over 70 years: Report from the Milwaukee cardiovascular data registry. Clin Cardiol 1987; 10: 377–382.
10.1002/clc.4960100703
CASPubMedWeb of Science®Google Scholar
7Faro RS, Golden MD, Javid H et al. Coronary revascularization in septuagenarians. J Thorac Cardiovasc Surg 1983; 86: 616–620.
CASPubMedWeb of Science®Google Scholar
8Johnson FA, Spyt T, Reece I et al. CABG in the elderly: The Glasgow experience. Gerontology 1989; 35: 165–170.
10.1159/000213016
PubMedWeb of Science®Google Scholar
9Kowalchuk GJ, Siu SC, McAuliffe LS et al. Coronary artery bypass surgery in octogenarians: Early and late results. J Am Coll Cardiol 1990; 15: 35A.
10.1016/0735-1097(90)91860-W
Google Scholar
10Kahn SS, Nissem S, Gray R et al. Long term prognosis of octogenarians undergoing coronary artery bypass surgery. J Am Coll Cardiol 1990; 15: 116A.
10.1016/0735-1097(90)92181-Z
Google Scholar
11Johnson WD, Gessert RJ, Brenowitz JB. Complex cardiovascular surgery in the geriatric population. Circulation 1987; 76: IV–486.
Google Scholar
12Loop FD, Lytle BW, Cosgrove DM et al. Coronary artery bypass graft surgery in the elderly. Cleve Clin J Med 1988; 55: 23–34.
10.3949/ccjm.55.1.23
CASPubMedWeb of Science®Google Scholar
13Rahimtoola SH, Grunkemier GL, Starr A. Ten year survival after coronary artery bypass surgery for angina in patients aged 65 years and older. Circulation 1986; 74: 509–517.
10.1161/01.CIR.74.3.509
CASPubMedWeb of Science®Google Scholar
14Mock MB, Holmes DR, Vlietsra RE et al. Percutaneous transluminal coronary angioplasty (PTCA) in the elderly patient: Experience in the National Heart, Lung, and Blood Institute PTCA Registry. Am J Cardiol 1984; 53: 89C–91C.
10.1016/0002-9149(84)90754-9
CASPubMedWeb of Science®Google Scholar
15Dorros G, Janke L. Percutaneous transluminal coronary angioplasty in patients over the age of 70 years. Cathet Cardiovasc Diagn 1986; 12: 223–229.
10.1002/ccd.1810120405
CASPubMedWeb of Science®Google Scholar
16Dorros G, Lewin RF, Mathiak LM. Percutaneous transluminal coronary angioplasty in patients over the age of 70 years. Cardiol Clin 1989; 7: 805–812.
10.1016/S0733-8651(18)30401-6
CASPubMedGoogle Scholar
17Holt GW, Sugrue DD, Bresnahan JF et al. Results of percutaneous transluminal coronary angioplasty for unstable angina pectoris in patients 70 years of age and older. Am J Cardiol 1988; 61: 994–997.
10.1016/0002-9149(88)90113-0
CASPubMedWeb of Science®Google Scholar
18Jung SC, Ligon RW, Webb DL et al. Coronary angioplasty in patients over the age of 70: An analysis of early and late results and influence of experience on outcome. J Am Coll Cardiol 1990; 15: 34A.
10.1016/0735-1097(90)91858-R
Google Scholar
19Simpfendorfer C, Raymond R, Schraider J et al. Early and long-term results of percutaneous transluminal coronary angioplasty in patients 70 years of age and older with angina pectoris. Am J Cardiol 1988; 62: 959–961.
10.1016/0002-9149(88)90901-0
CASPubMedWeb of Science®Google Scholar
20Raizner AE, Hust RG, Lewis JM et al. Transluminal coronary angioplasty in the elderly. Am J Cardiol 1986; 57: 29–32.
10.1016/0002-9149(86)90946-X
CASPubMedWeb of Science®Google Scholar
21Mills TJ, Smith HC, Vlietstra RE. PTCA in the elderly: Results and expectations. Geriatrics 1989; 44: 71–79.
CASPubMedWeb of Science®Google Scholar
22Kern MJ, Deligonul U, Galan K et al. Percutaneous transluminal coronary angioplasty in octogenarians. Am J Cardiol 1988; 61: 457–458.
10.1016/0002-9149(88)90304-9
CASPubMedWeb of Science®Google Scholar
23Rich JJ, Crispino CM, Saporito J et al. Percutaneous transluminal angioplasty in patients 80 years of age and older. Am J Cardiol 1990; 65: 665–676.
10.1016/0002-9149(90)91051-7
Web of Science®Google Scholar
24Little T, Mukherjee D, Lee K et al. Coronary angioplasty in octogenarians. J am Coll Cardiol 1990; 15: 34A.
10.1016/0735-1097(90)91859-S
Google Scholar
25Shani J, Charlap S, Mylavarapu S et al. PTCA in the young and old: More similar than different. J Am Geriatr Soc 1989; 37: P80.
Google Scholar
26Kowalchuk GJ, Siu SC, Lewis SM. Coronary artery disease in the octogenarian: Angiographic spectrum and suitability for revascularization. Am J Cardiol 1990; 66: 1319–1323.
10.1016/0002-9149(90)91161-X
CASPubMedWeb of Science®Google Scholar
27Jeroudi MO, Kleiman NS, Minor ST et al. Percutaneous transluminal coronary angioplasty in the elderly: Early and long-term results. J Am Coll Cardiol 1990; 113: 423–428.
PubMedWeb of Science®Google Scholar
28Thompson RC, Holmes DR, Gersh BJ et al. Percutaneous transluminal coronary angioplasty in the elderly: Early and long-term results. J Am Coll Cardiol 1991; 17: 1245–1250.
10.1016/S0735-1097(10)80130-5
CASPubMedWeb of Science®Google Scholar
29Myler RK, Webb JG, Nguyen KP et al. Coronary angioplasty in octogenerians: Comparisons to coronary bypass surgery. Cathet Cardiovasc Diagn 1991; 23: 3–9.
10.1002/ccd.1810230103
CASPubMedWeb of Science®Google Scholar
30Jackman JD, Navetta FI, Smith JE et al. Percutaneous transluminal coronary angioplasty in octogenarians as an effective therapy for angina pectoris. Am J Cardiol 1991; 68: 116–119.
10.1016/0002-9149(91)90724-Y
PubMedWeb of Science®Google Scholar
31Rizo-Patron C, Hamad N, Paulus R et al. Percutaneous transluminal coronary angioplasty in octogenarians with unstable coronary syndromes. Am J Cardiol 1990; 66: 857–858.
10.1016/0002-9149(90)90365-8
CASPubMedWeb of Science®Google Scholar
32Imburgia M, King TR, Soffer AD et al. Early results and long-term outcome of percutaneous transluminal coronary and angioplasty in patients age 75 years or older. Am J Cardiol 1989; 63: 1127–1129.
10.1016/0002-9149(89)90091-X
CASPubMedWeb of Science®Google Scholar
33Macaya C, Alfonso F, Iniguez A, Zarco P. Long-term clinical and angiographic follow-up of percutaneous transluminal angioplasty in patients ≥65 years of age. Am J Cardiol 1990; 66: 1513–1515.
10.1016/0002-9149(90)90546-D
CASPubMedWeb of Science®Google Scholar
34Wei JY, Gersh BJ. Heart disease in the elderly. In: Curr Prob Cardiol Year Book Medical Publishers. 1987; 12: 3–65.
Google Scholar
35Safian RD, McCabe CH, Sipperly ME et al. Initial success and long-term follow-up of percutaneous transluminal coronary angioplasty in chronic total occlusions versus conventional stenoses. Am J Cardiol 1988; 61: 23G–28G.
10.1016/S0002-9149(88)80028-6
CASPubMedWeb of Science®Google Scholar
36Kelsey SF, Miller DP, Holubkov R et al. Results of percutaneous transluminal coronary angioplasty in patients ≥65 years of age (from the 1985 to 1986 National Heart, Lung, and Blood Institute's Coronary Angioplasty Registry). Am J Cardiol 1990; 66: 1033–1038.
10.1016/0002-9149(90)90500-Z
CASPubMedWeb of Science®Google Scholar
37Wohlgelemter D, Cleman M, Highman HA, Zaret BL. Percutaneous transluminal coronary angioplasty of the “Culprit Lesion” for management of unstable angina pectoris in patients with multivessel coronary artery disease. Am J Cardiol 1986; 58: 460–464.
10.1016/0002-9149(86)90015-9
PubMedWeb of Science®Google Scholar
38Bedotto JB, Rutherford BD, McConahay DR et al. Results of multivessel percutaneous transluminal coronary angioplasty in persons aged 65 years and older. Am J Cardiol 1991; 67: 1051–1055.
10.1016/0002-9149(91)90864-H
CASPubMedWeb of Science®Google Scholar

Citing Literature

Volume40, Issue1

January 1992

Pages 19-22

PTCA in the Elderly: The “Young-Old” versus the “Old-Old”

Abstract

Objective

Design

Setting

Patients

Interventions

Results

Conclusions

REFERENCES

Citing Literature

References

Information

About Wiley Online Library

Help & Support

Opportunities

Connect with Wiley

PTCA in the Elderly: The “Young-Old” versus the “Old-Old”

Abstract

Objective

Design

Setting

Patients

Interventions

Results

Conclusions

REFERENCES

Citing Literature

References

Related

Information