Results of multivessel percutaneous transluminal coronary angioplasty in persons aged 65 years and older

Abstract

Between 1981 and 1990, 1,373 patients, aged ≥65 years (mean 71.2 ± 4.9), underwent 1,640 multivessel percutaneous transluminal coronary angioplasty (PTCA) procedures. Of these, 224 patients (13.6%) had a left ventricular ejection fraction ≤40%, 412 (25.1%) had prior coronary artery bypass grafting (CABG) and 48 (2.9%) had left main artery dilatation. Of the 1,640 PTCA procedures, 697 were in patients with 2-vessel disease and 943 were in patients with 3-vessel disease. A mean 3.5 lesions were dilated per patient, with an overall angiographic success rate of 96%. Complete revascularization was achieved in 857 (52%). A total of 52 patients (3.2%) had a major in-hospital complication: 27 patients (1.6%) died, 24 (1.4%) had a Q-wave myocardial infarction, and 14 (0.8%) underwent emergent CABG. Stepwise logistic regression analysis identified ejection fraction ≤40% (p ≤ 0.001), 3-vessel disease (p ≤ 0.01), female gender (p ≤ 0.02), and PTCA between 1981 and 1985 (p ≤ 0.05) as independent predictors of mortality. Of the 1,373 patients, 1,023 have been followed for ≥1 year (mean follow-up 32.5 ± 21.3 months). There were 156 (15.2%) late deaths, 81 (7.9%) recurrent myocardial infarctions, and 162 (15.8%) coronary artery bypass operations. Actuarial survival, computed from the time of hospital discharge, was 92% at 1 year, 86% at 3 years and 78% at 5 years. Repeat PTCA was required in 371 patients (36.3%). Survival was better in those with 2-versus 3-vessel disease (p ≤ 0.008) and in those with complete versus partial revascularization (p ≤ 0.001). These data indicate that multivessel PTCA is an effective and safe alternative to CABG in older patients with symptomatic coronary artery disease.