Coronary angioplasty in octogenarians

Coronary balloon angioplasty was performed on 33 lesions during 28 procedures in 23 octogenarians (median age 83, range 80 to 87 years) between January 1989 and December 1991. 96% of the patients had grade III-IV angina pectoris. The median left ventricular ejection fraction was 64% (range: 38-85%). Single vessel coronary artery disease was present in 43% and multivessel coronary artery disease in 57%. Angioplasty was performed on 1 vessel in 85% of the procedures and on 2 vessels in 15%. Primary angiographic success was 97% for 33 attempted lesions with one failure to recanalize an old occlusion. One patient underwent emergency intracoronary stent implantation after failed angioplasty. None underwent emergency coronary bypass surgery. One patient (4%) had a myocardial infarction and 2 patients (7%) died during hospitalization, the first because of abrupt vessel closure during angioplasty, the second due to acute retroperitoneal bleeding on the 8th day post-angioplasty while fully anticoagulated for an intracoronary stent. Follow-up (median 17, range 8 to 39 months) was obtained for all patients. Out of the 21 patients with primary angioplastic success, 3 (14%) had died (1 cardiac and 2 non-cardiac). At 1 year actuarial survival was 86%, and survival free from myocardial infarction or coronary bypass surgery was 81%. Further angioplasty for either restenosis or another lesion was performed in 5 patients (24%). These results confirm that coronary angioplasty is an effective means of controlling anginal symptoms in a selected group of severely symptomatic octogenarians. However, when complications do occur they are linked to a significant mortality rate.(ABSTRACT TRUNCATED AT 250 WORDS)