Percutaneous transluminal coronary angioplasty in patients over the age of 70 years

Abstract

Percutaneous transluminal coronary angioplasty (PTCA) was attempted in 109 patients over the age of 70 years (mean age 75.9). The patients' clinical characteristics showed 55% with multivessel coronary disease, 86% with significant angina pectoris (Class II to IV), 16% with prior bypass surgery, and 2.7% with left ventricular dysfunction. Angioplasty data showed the mean percent diameter stenosis was reduced from 83 +/- 12% to 15 +/- 16%. One lesion was dilated in 67%, two lesions in 30%, and three lesions in 3% of the patients. A successful dilatation was achieved in 138/148 lesions (89%) with 90/109 patients (83%) clinically improved at hospital discharge. Significant complications were encountered in six patients (5.5%): three transmural infarctions (2.8%), two mortalities (1.8%), and one emergency surgical procedure (0.9%). Follow-up data (greater than or equal to 1 year) are available in 77 patients: 68 patients (92%) had an improved anginal status [49 patients (65%) had no angina]. During a mean follow-up of 23 +/- 10 months, there were two myocardial infarctions and three deaths. A clinically apparent recurrence occurred in 14 patients (17%). Repeat angioplasty was successfully performed in 13/14 patients. Bypass surgery was performed during the follow-up in three patients (two of whom had had a recurrence after a second successful angioplasty; one patient died during elective surgery). Transluminal coronary angioplasty can be performed in patients over age 70 with a good success rate, an acceptable complication rate, a relatively low clinically apparent recurrence rate, and should be considered as a therapeutic modality and alternative for the selected geriatric patient.