The so-called "frail elderly" (80 years or older) who undergo coronary angioplasty are eight times more apt to die in the hospital after the procedure than younger elderly patients. They also face a marginal increase in the risk of heart attack after the procedure, according to a study supported in part by the Agency for Health Care Policy and Research (HS06813).
Age has been found to be an independent risk factor for death in other cardiovascular studies. Thus, it is likely that the increased death rate in the very elderly reflects, in part, a decreased myocardial reserve as well as a decreased system reserve in general. These are risks that should be carefully considered by both physicians and their elderly patients, recommends David E. Wennberg, M.D., M.P.H., of the Maine Medical Center, the study's lead author.
Dr. Wennberg and his colleagues collected data from 1989 through 1993 on coronary angioplasty outcomes for more than 12,000 patients hospitalized at five New England hospitals considered to be regional centers for bypass surgery and angioplasty. They explored the relationship between older age and clinical presentation, procedural success, and inpatient outcomes across four age groups (less than 60, 60 to 69, 70 to 79, and 80 years and above). Patients 80 or older (4 percent of patients) were more apt to be women and to have multiple vessels blocked, more severe blockage, and complex lesions. The proportion of patients with two or more vessels with significant blockage increased from 32 percent for those under 60 years to 58 percent in those 80 years and older.
Despite more severe disease, the oldest patients had angiographic success that was nearly identical to that of younger patients. According to the authors, this was probably due to the experience and expertise of the regional heart centers. Nevertheless, they had more than an eight-fold increase in the rate of inpatient post-angioplasty death compared with those less than 60 years of age (3.16 vs. 0.36 percent). There also was a slight nonsignificant increase in heart attacks following the procedure for patients over 80 compared with those under 60 years (3.35 vs. 2.05 percent).
See "Percutaneous transluminal coronary angioplasty in the elderly: Epidemiology, clinical risk factors, and in-hospital outcomes," by Dr. Wennberg, David J. Malenka, M.D., M.S., Anjana Sengupta, Ph.D., and others, in the April 1999 American Heart Journal 137, pp. 639-645.