709-1 Coronary Angioplasty in 20,006 Patients Over Age 80 in the United States

Abstract

The use of coronary angioplasty (PTCA) in the very elderly has undergone explosive growth. Using the Medicare Provider Analysis and Review (MEDPAR) file from 1987 through 1990, we examined PTCA for all patients greater than 80 years old. The demographics of these patients included mean age 82.6 (range 80–100, 1st Quartile 81, Median 82, 3rd Quartile 84), 45% women, 3.9% non-whsite, 25.2% involving acute myocardial infarction admissions (AMI), 25.4% having Charlson comorbidity index 1 or greater. The annual number of patients over age 80 undergoing PTCA more than doubled over the course of the study: 1987–3082, 1988–4284, 1989–5369, 1990–7341. Short and intermediate term outcomes of these patients are listed below: Patient group LOS In-hospital mortality 1 year mortality 3 year mortality All patients > 80 4 7.0% * 17.0% * 29.6% * AMI > 80 - 15.8% * 24.6% * 35.0% * All patients 65–69 5 1.8% * 5.2% * 10.4% * U.S. Population age 82 - - 7.7% 23.6% LOS = median length of stay after PTCA in days * 99% confidence intervals within 0.2% Patients over age 80 had significantly higher in-hospital and intermediateterm mortality following PTCA compared to 65–69 year old patients in the MEDPAR file. However, their survival at 3 years was comparable to survival for the age-matched general United States (U.S.) population. This study is the largest reported series of PTCA in very elderly patients, and includes the majority of patients over age 80 treated in the U.S. during the study period. With the growth of the elderly population and the increased use of PTCA in these very elderly patients, information concerning their outcomes are important in guiding treatment decisions