PERCUTANEOUS CORONARY INTERVENTION
(PCI) IN THE ELDERLY: A COMPARISON OF PROCEDURAL AND CLINICAL OUTCOMES BETWEEN
THEIR EIGHTH AND NINTH DECADES C.H. Ang*, R.A.P. Skyme-Jones, R.W. Harper, I.T. Meredith. Centre for Heart and Chest Research, Monash University, Monash
Medical Centre, Melbourne. We compared the short-term safety and outcome of percutaneous
coronary interventions (PCI) in elderly in their ninth decade (patients
aged >= 80 years) with those in their eighth decade (aged 70-79
years). 589 patients aged >= 70 years
underwent coronary angioplasty were stratified into two groups, those being
aged >= 80 years (Group I, 65 patients) and
those aged 70-79 years (Group II, 524 patients). Group I comprised more females (75% vs 52%), had a higher incidence of hypertension (70% vs 56%) and untreated hyperlipidaemia
(18% vs 7%). There were fewer obese
patients as determined by body mass index (20% vs 32%). Group I had more patients presenting with acute coronary
syndromes (75% vs 52%, p<0.001,
multivessel disease (63% vs 54%,
p=0.012), complex lesion and stent insertion (82% vs 66%, p=0.013). The angiographic and clinical success per lesion
were similar in the two groups (95.9% vs
94.3% and 89.2% vs 89.5% in Groups I
and II respectively). The incidence of death, Q and non-Q wave infarct,
emergency bypass and repeat angioplasty, stroke and local vascular
complications were similar in both groups. (1.5% vs 1.1%, 0% vs 0.6%, 6.2% vs
2.9%, 0% vs 1.3%, 3% vs 1.7%, 1.5% vs 0.4% and 4.6% vs 4.4%
respectively). However, Group I had a longer stay in hospital (4 days vs 2 days, p<0.001). PCI is equally
effective and safe in patients aged >=80 years of age.
The high clinical success rate with an acceptably low incidence of major
complication rates and clinical events support the use of more aggressive
treatment strategies in this group.
