Percutaneous transluminal coronary angioplasty in octogenarians

Kern, Morton J.; Deligönül, Ubeydullah; Galan, Kathy; Zelman, Robert; Gabliani, Gregory; Bell, Stephen T.; Bodet, Joseph; Naunheim, Keith S.; Vandormael, Michel

doi:10.1016/0002-9149(88)90304-9

Cited by 69 publications

(18 citation statements)

References 5 publications

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“…In the early days of angioplasty. Mock et al [9] and others [10,11] reported significantly lower success rates (only 50-70%) and higher complications in patients older than 65 years. An ex tremely high mortality rate (19%) was reported in a small group of octogenarians [10].…”

Section: Discussionmentioning

confidence: 98%

“…Mock et al [9] and others [10,11] reported significantly lower success rates (only 50-70%) and higher complications in patients older than 65 years. An ex tremely high mortality rate (19%) was reported in a small group of octogenarians [10]. More recent experience, with better equipment, patient selection and operator experi ence has resulted in improved success rates (80-95%); however, mortality remained higher in older patients [12][13][14][15].…”

Section: Discussionmentioning

confidence: 98%

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Age- and Gender-Related Differences in Success, Major and Minor Complication Rates and the Duration of Hospitalization after Percutaneous Transluminal Coronary Angioplasty

Rozenman

Gilon²,

Zelingher³

et al. 1996

Cardiology

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This report describes the effect of age and gender on the results of balloon angioplasty using current technique and indications. A consecutive group of 2,067 patients who underwent angioplasty at a single institution after 1990 is described. Angioplastic success was 92.2% and similar among men and women and the various age groups. Sixteen patients (0.8%) died, and mortality among women was significantly higher (1.4 vs. 0.6%, p < 0.001). There were no age or gender differences in the rate of Q-wave myocardial infarction and the need for coronary artery bypass. Minor complications such as groin complications (10.5% women, 5.0% men; p < 0.001) and infections (6.4% women, 3.7% men; p < 0.05) were more common in women, and as a result the duration of hospitalization after angioplasty was longer. The length of hospitalization after angioplasty was longer with advanced age, mainly as a result of higher groin complications (p < 0.001), infections (p < 0.01) and renal failure (p < 0.05). We conclude that using current indications and technique, angioplasty can be performed safely with a high success rate. Mortality is higher among women. The length of hospitalization after angioplasty is longer in women and, at advanced age, due to higher rate of minor complications.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 98%

Age- and Gender-Related Differences in Success, Major and Minor Complication Rates and the Duration of Hospitalization after Percutaneous Transluminal Coronary Angioplasty

Rozenman

Gilon²,

Zelingher³

et al. 1996

Cardiology

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“…Some of the papers published in the late eighties through nineties showed the success rate of percutaneous transluminal coronary angioplasty (PTCA) in the elderly to be approximately 82%-84% and highly variable mortality rates [47][48][49] , however, Both success and mortality rates have varied a lot in other papers published in the same era. Kern et al [50] reported in 1988 a clinical success rate of a 67% in a group of 21 patients who had undergone PTCA in their octogenarian years. After that, a clinical success rate of 57% was reported in 43 patients aged 75 years and older by other investigators [51] .…”

Section: Pci Temporal Trendsmentioning

confidence: 99%

“…Procedure success has differed considerably between septuagenarians, octogenarians and older participants in the same group of old aged patients as it was 85%, 73%, and as low as 50% for patients aged 70 to 74, 75 to 79, and 80 years and older [49] . Also, procedural mortality rate varied and reached up to 19% during the same era [50,53] . Many cardiac and non-cardiac complications were reported and occurred in more than third of the participants in some of the previous studies [47,50] .…”

Section: Pci Temporal Trendsmentioning

confidence: 99%

“…Also, procedural mortality rate varied and reached up to 19% during the same era [50,53] . Many cardiac and non-cardiac complications were reported and occurred in more than third of the participants in some of the previous studies [47,50] . Although PCI has been proven to be feasible in the older population, the previous rates of success, procedural mortality, and consequent complications were unacceptable to many healthcare providers which created a high level of prudence and caution before deciding to perform PCI on such patients.…”

Section: Pci Temporal Trendsmentioning

confidence: 99%

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Percutaneous coronary intervention in the elderly: current updates and trends

Arisha¹,

Ibrahim²,

Abouarab³

et al. 2018

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Ischemic heart disease is the leading cause of death with acute coronary syndrome accounting for more than 30% of causes of mortality in the elderly population. The rate of growth of the older segment of the population has increased exponentially and will become more pronounced in the future. Historically, there has been a paucity of clinical trials investigating the challenges and outcomes of more invasive treatment strategies such as percutaneous coronary intervention (PCI) for that very segment of the population. However, the safety, efficacy, and outcomes of PCI in the older population have started to receive more attention, leading to some changes in their trends. There are several factors that make interventional cardiologists more resistant to direct the elderly to PCI. Most of these challenging factors, such as the complexity of coronary lesions, frailty, hematological and vascular changes, are discussed in this review. In addition. more advanced technologies have been introduced to PCI platform such as second-and thirdgenerations stents, several alternative approaches have been adopted like transradial approach and the usage of bivalirudin instead of heparin and GP IIb/IIIa inhibitor, and several imaging modalities have been optimized to assess patients' outcome and prognosis more accurately. Several recent studies have shown better results when these strategies are adopted. The most recent recommendations regarding performing PCI in the elderly are also discussed in this review.

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Coronary angioplasty in octogenarians: Comparisons to coronary bypass surgery

Myler

Webb

Nguyen

et al. 1991

Cathet. Cardiovasc. Diagn.

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Coronary angioplasty was performed in 74 patients 80 years of age and older (mean 83 +/- 3). Single vessel coronary disease was present in 34% and multivessel coronary disease in 66%. Angioplasty of a single vessel was performed in 51 patients (69%), while 23 (31%) had angioplasty of multiple vessels. Angioplasty was successful in 59 of 74 patients (80%). Angioplasty was unsuccessful but uncomplicated in 12 (16%) due to (unyielding) calcified lesions or (impassable) old occlusions. Of these 12, 8 were discharged on medical therapy and 4 underwent elective uncomplicated bypass surgery prior to discharge. Three (4%) patients required emergency coronary bypass surgery due to abrupt vessel closure during the angioplasty procedure, with one hospital death (1.4%). Follow-up (mean 24 +/- 22 months) was obtained in all patients. Of the 59 successful angioplasty patients, late mortality was 10% (cardiac 7% and non-cardiac 3%). Survival and survival without myocardial infarction were both 90%; survival without either infarction or bypass surgery was 86%. Actuarial 3-year survival was 91% and 3-year freedom from death, infarction or bypass surgery was 87% by life-table analysis. Repeat angioplasty for restenosis was performed in 7 patients (12%) without complications.

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Percutaneous transluminal coronary angioplasty in octogenarians

Cited by 69 publications

References 5 publications

Age- and Gender-Related Differences in Success, Major and Minor Complication Rates and the Duration of Hospitalization after Percutaneous Transluminal Coronary Angioplasty

Age- and Gender-Related Differences in Success, Major and Minor Complication Rates and the Duration of Hospitalization after Percutaneous Transluminal Coronary Angioplasty

Percutaneous coronary intervention in the elderly: current updates and trends

Coronary angioplasty in octogenarians: Comparisons to coronary bypass surgery

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