Percutaneous transluminal coronary angioplasty in the elderly: Epidemiology, clinical risk factors, and in-hospital outcomes,☆☆,

Presented in part at the 1995 Annual Meeting of the American College of Cardiology.
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Abstract

Objectives To explore the relation between older age and clinical presentation, procedural success, and in-hospital outcomes among a large unselected population undergoing percutaneous transluminal coronary angioplasty (PTCA). Background Although more elderly patients are receiving PTCA, studies of post-PTCA outcomes among the elderly have been limited by small numbers and exclusive selection criteria. Methods Data were collected as a part of a prospective registry of all percutaneous coronary interventions performed in Maine, New Hampshire, and from 1 institution in Massachusetts between October 1989 and December 1993. Comparisons across 4 age groups, (<60, 60 to 69, 70 to 79, and 80 years and above) were performed using chi-square tests, the Mantel-Haenzsel test for trend, and logistic regression. Results Twelve thousand one hundred seventy-two hospitalizations for PTCA were performed with 507 of them (4%) in persons at least 80 years old. Octogenarians were more likely to be women, have multivessel disease, high-grade stenoses, and complex lesions but were less likely to have hypercholesterolemia, a history of smoking, or have undergone a previous PTCA. In the elderly, PTCAs were more often performed urgently and for unstable syndromes compared with younger age groups. Advancing age is strongly associated with in-hospital death, and among the oldest old with an increased risk of postprocedural myocardial infarction. Despite differing presentation and procedural priority, angiographic success and subsequent bypass surgery did not vary by age. Conclusions With the increasing age of the population at large as well as that segment at risk for cardiac revascularization, information about age-associated risks of the procedure, especially the substantially higher risk of death in octogenarians, will be critical for both physicians and patients considering PTCA. (Am Heart J 1999;137:639-45.)

Section snippets

Methods

The Northern New England Cardiovascular Disease Study Group is a voluntary research consortium of clinicians, research scientists, and hospital administrators associated with the 5 sole regional providers of CABG and PTCA in Maine, New Hampshire, and Vermont, and 1 institution in Massachusetts with similar services. The group’s mission is “...to provide accurate and timely information concerning the management of cardiovascular disease.” Since 1987, this group has met 3 times per year and

Results

Table I shows the characteristics of the PTCA population stratified by age.

. Baseline demographics, risk factors, indication, and priority of the procedure by age group

CharacteristicsAge (y)Missing (%)
<6060 to 6970 to 79≥80
Patients n (%) (n = 12,172)5217 (42.9)3752 (30.8)2696 (22.1)507 (4.2)
Mean age (y)50.064.573.782.6
Female (%)22.533.445.956.90.18
Cardiac risk factors (%)
 Hypertension44.354.659.460.31.73
 Treated diabetes16.924.424.326.31.51
 Hypercholesterolemia63.156.647.733.39.57
 Family Hx

Discussion

For patients undergoing angioplasty, advancing age brings striking changes in patient and disease characteristics. Older patients in our cohort were more likely to be women and have a lower prevalence of smoking and family history of premature coronary artery disease. These changes largely reflect the demographics found in the population at large. Women are more likely to survive into their eighth decade than men and the sex-specific prevalence of coronary artery disease is nearly equal after

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    Supported in part by a grant from the Agency for Health Care Policy and Research, Washington, DC (HSO 6812).

    ☆☆

    Reprint requests: David E. Wennberg, MD, MPH, Division of Health Services Research, Department of Medicine, Maine Medical Center, 22 Bramhall St, Portland, ME 04102.E-mail: [email protected]

    0002-8703/99/$8.00 + 0   4/1/93035

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