Coronary Artery Disease In Elderly Research Articles

Effectiveness of Atorvastatin Combined with Trimetazidine in the Treatment of Coronary Heart Disease in the Elderly and Their Effect on Cardiac Function

Objective: To analyze the effect of atorvastatin combined with trimetazidine in the treatment of elderly coronary artery disease and the effect on patients’ cardiac function. Methods: 60 cases of elderly coronary artery disease patients were divided into 2 groups by randomization method, and all of them received conventional symptomatic treatment, while atorvastatin was added to the control group and trimetazidine was combined with atorvastatin in the observation group, and the clinical indexes were compared. Results: After treatment, the angina attack, cardiac function indexes, and inflammatory factor levels of the observation group were better than those of the control group (P < 0.05), and the differences in adverse reactions between the two groups were not significant (P > 0.05). Conclusion: Combined treatment of coronary heart disease in the elderly with atorvastatin and trimetazidine can positively reduce angina symptoms, improve cardiac function, and reduce inflammatory reactions, and the effect is definite.

Approaches to predicting life expectancy in elderly coronary artery disease patients with comorbid conditions

The aim of the study was to develop a model for predicting the probability of survival up to 80 years of age for elderly and senile patients with coronary artery disease (CAD) and concomitant conditions. Materials and methods. A retrospective data analysis of elderly and senile CAD patients who were observed in the period 1997–2019 and died from a cardiovascular event. Results. Using binary logistic regression analysis, a model of the survival probability up to 80 years in CAD patients with comorbid conditions has been developed. The overall accuracy of the model was 83.12 % (χ2 = 6.70, p < 0.05), and the predictive accuracy of the model (AUC = 0.853, 95 % CI 0.802–0.896) was sufficiently high and adequate to use in clinical practice. Odds ratio has shown a greater contribution of arterial hypertension and diabetes mellitus to reduced probabilities of surviving to the age of 80, a less significant contribution – of chronic obstructive pulmonary disease and dyslipidemia. Conclusions. The developed model for predicting the survival probability up to 80 years for older age group patients with coronary artery disease and comorbid conditions can be used to evaluate the effectiveness and correct medical and preventive measures.

Performance of PRECISE-DAPT and Age-Bleeding-Organ Dysfunction Score for Predicting Bleeding Complication During Dual Antiplatelet Therapy in Chinese Elderly Patients.

BackgroundRecently, the Age–Bleeding–Organ Dysfunction (ABO) algorithm was recommended by the Asian Pacific Society of Cardiology Consensus as a binary approach to evaluate bleeding risk. This analysis made comparison of the predictive performances between the PRECISE-DAPT and ABO bleeding score in identifying the risk of 12-months major bleeding in Chinese elderly patients over 65 years old patients who underwent percutaneous coronary intervention (PCI) during dual-antiplatelet therapy period.MethodsA total of 2,037 elderly coronary artery disease (CAD) patients (≥65 years) receiving dual antiplatelet therapy (DAPT) after PCI were enrolled in the study. The predictive accuracy of the two bleeding risk scores (PRECISE-DAPT and ABO) was compared for identifying the risk of bleeding during the dual-antiplatelet therapy in patients who underwent PCI. Major clinically relevant bleeding events were defined according to the Bleeding Academic Research Consortium (BARC) criteria.ResultsThe PRECISE-DAPT score in the no bleeding, BARC = 1 bleeding, BARC ≥ 2 bleeding patients was 23.55 ± 10.46, 23.23 ± 10.03, and 33.54 ± 14.33 (p < 0.001), respectively. Meanwhile, the ABO score in the three groups was 0.72 ± 0.80, 0.69 ± 0.81, and 1.49 ± 0.99 (p < 0.001), respectively. The C-statistic of the PRECISE-DAPT model for prediction of BARC ≥ 2 bleeding in overall patients was 0.717 (95% CI, 0.656–0.777) and 0.720 (95% CI, 0.656–0.784) in acute coronary syndrome (ACS) patients. Similar discriminatory capacity was demonstrated in the ABO risk score [overall, patients, AUC: 0.712 (95% CI, 0.650–0.774); ACS patients, AUC: 0.703 (95% CI, 0.634–0.772)]. No differences were observed when the ABO model was in comparison with the PRECISE-DAPT model, regardless in overall patients (z = −0.199, p = 0.842) or ACS patients (z = −0.605, p = 0.545). The calibration for BARC ≥ 2 bleeding of the PRECISE-DAPT and ABO score were acceptable, regardless in overall patients [goodness-of-fit (GOF) Chi-square = 0.432 and 0.001, respectively; p-value = 0.806 and 0.999, respectively] or ACS patients (GOF Chi-square = 0.008 and 0.580, respectively; p-value = 0.996 and 0.748, respectively).ConclusionNo matter of clinical presentation in Asian 65-years older patients with DAPT, the PRECISE-DAPT, and ABO scores had the similar discriminative ability for 12-months BARC ≥ 2 bleeding. Considering the simplicity and reliability, the PRECISE-DAPT score might be more clinically applicable in the overall population and ACS patients in bleeding prediction.

CLINICO EPIDEMIOLOGICAL PROFILE OF CORONARY ARTERY DISEASE IN THE YOUNG INDIVIDUALS

Background: In India as well as the rest of the world, cardiovascular disease (CVD) is the leading cause of death. The prevalence of coronary artery disease (CAD) is increasing in young adults as a result of the epidemiological change. Data on the epidemiological, clinical, and angiographic profiles of young individuals with ACS in India are scarce. Methods: The current prospective observational study was conducted in Department of Cardiology, SCB Medical College &amp; Hospital, Cuttack, Odisha, India with a high patient volume. A total of 30 cases (young patients 40 yrs. with acute myocardial infarction), 10 age-matched healthy controls, and 10 elderly patients (&gt;40 yrs.) with CAD were investigated, their histories thoroughly reviewed, and their clinical conditions thoroughly examined. Results: This study found that the average age of the cases was 34.4 years. HDL-C was lower than in the control group, the mean blood triglyceride and LDL-cholesterol increased in the case group. Serum Lp(a) levels were significantly higher in the case group (P=0.045) compared to controls and elderly CAD. Conclusion: The most typical ACS presentation in the young population was STE-ACS. The most prevalent risk factor was smoking. First medical contact and revascularization were delayed significantly, and the majority of the patients had single-vessel illness.

Retrospective analysis of renal prognosis in elderly coronary artery disease patients complicated with renal insufficiency.

Objective and Methods: The aim of this study was to retrospectively analyze the renal prognosis of elderly coronary artery disease (CAD) patients complicated with renal insufficiency.Results: A total of 307 patients were included. The mean follow-up period was 25±11months. The average age was 79±7 years. In the worsening renal function group, there were higher occurrence rate of heart failure and severe coronary artery stenosis, lower rate of percutaneous coronary intervention, lower medication rate of renin-angiotensin blocker, lower plasma albumin, magnesium and hemoglobulin level. There was no significant difference in the rate of worsening renal function or gastrointestinal bleeding between patients who took anti-platelet agents/statins and those without. Patients with reduced left ventricular ejective fraction had higher rate of worsening renal function, yet lower medication rate of renin-angiotensin blockers, lower plasma albumin and hemoglobulin level. Anemia, malnutrition and worsening cardiac function were risk factors of renal function deterioration and mortality.Conclusions: In the elderly coronary artery disease patients who had renal insufficiency, antiplatelet agents and statin have non-adverse effects on renal function; lower medication rate of renin-angiotensin blocker were found in patients with either worsening renal function or heart failure. Anemia, malnutrition and worsening cardiac function are risk factors of renal function deterioration and mortality.

Trimetazidine offers myocardial protection in elderly coronary artery disease patients undergoing non-cardiac surgery: a randomized, double-blind, placebo-controlled trial

BackgroundTrimetazidine (TMZ) pretreatment protects cardiomyocytes during cardiac surgery. TMZ may protect elderly patients with ischaemic heart disease (IHD) undergoing non-cardiac surgery.MethodsThis was a randomized, double-blind, placebo-controlled trial (registration #ChiCTR1900025018) of patients with IHD scheduled to undergo non-cardiac surgery at Shenzhen People’s Hospital (Shenzhen, Guangdong Province, China) between June 2014 and September 2015, randomized to 60 mg TMZ or placebo 12 h before surgery. The primary endpoint was the occurrence of in-hospital cardiovascular events. The secondary endpoints were myocardial ischaemia on five-lead electrocardiogram (cECG), cardiac troponin I (cTnI) elevation, cardiac death, acute coronary events, heart failure, and arrhythmia requiring treatments.ResultsCompared with the placebo group, the TMZ group showed a lower occurrence of in-hospital cardiovascular events (primary endpoint, 20.0% vs. 37.5%, P = 0.02), myocardial ischaemia (15.0% vs. 32.5%, P < 0.01), cTnI elevation (2.5% vs. 10%, P < 0.01), acute coronary events (10.0% vs. 20.0%, P < 0.05), heart failure (0% vs. 2.5%, P < 0.05), and arrhythmia requiring treatment (17.5% vs. 35.0%, P < 0.05). There was no acute myocardial infarction during the 30-day postoperative period.ConclusionsIn elderly patients with IHD undergoing non-cardiac surgery, TMZ pretreatment was associated with myocardial protective effects.Trial registration The trial was prospectively registered at http://www.chictr.org.cn/showproj.aspx?proj=41909 with registration number [ChiCTR1900025018] (7/8/2019).

Predictors of pre-rehabilitation exercise capacity in elderly European cardiac patients - The EU-CaRE study.

Functional capacity is an important endpoint for therapies oriented to older adults with cardiovascular diseases. The literature on predictors of exercise capacity is sparse in the elderly population. In a longitudinal European study on effectiveness of cardiac rehabilitation of seven European countries in elderly (>65 years) coronary artery disease or valvular heart disease patients, predictors for baseline exercise capacity were determined, and reference ranges for elderly cardiac patients provided. Mixed models were performed in 1282 patients (mean age 72.9 ± 5.4 years, 79% male) for peak oxygen consumption relative to weight (peak VO2; ml/kg per min) with centre as random factor and patient anthropometric, demographic, social, psychological and nutritional parameters, as well as disease aetiology, procedure, comorbidities and cardiovascular risk factors as fixed factors. The most important predictors for low peak VO2 were coronary artery bypass grafting or valve surgery, low resting forced expiratory volume, reduced left ventricular ejection fraction, nephropathy and peripheral arterial disease. Each cumulative comorbidity or cardiovascular risk factors reduced exercise capacity by 1.7 ml/kg per min and 1.1 ml/kg per min, respectively. Males had a higher peak VO2 per body mass but not per lean mass. Haemoglobin was significantly linked to peak VO2 in both surgery and non-surgery patients. Surgical procedures, cumulative comorbidities and cardiovascular risk factors were the factors with the strongest relation to reduced exercise capacity in the elderly. Expression of peak VO2 per lean mass rather than body mass allows a more appropriate comparison between sexes. Haemoglobin is strongly related to peak VO2 and should be considered in studies assessing exercise capacity, especially in studies on patients after cardiac surgery.

Effect of abdominal massage combined with Qingning pills in treatment of elderly coronary artery disease patients with constipation

Effect of abdominal massage combined with Qingning pills in treatment of elderly coronary artery disease patients with constipation

Effect of abdominal massage combined with Qingning pills in treatment of elderly coronary artery disease patients with constipation

Effect of abdominal massage combined with Qingning pills in treatment of elderly coronary artery disease patients with constipation

Pathological features at autopsy in elderly patients with acute myocardial infarction

Objective: To analyze the cardiac pathological features of elderly coronary artery disease (CAD) patients (60 years and over) and evaluate the pathological features at autopsy and risk factors of patients with acute myocardial infarction (AMI). Methods: Data from 471 elderly patients (aged from 60 to 100 years old) with CAD confirmed by autopsy hospitalized in our hospital from April 1969 to October 2013 were retrospectively reviewed. Patients were divided into 2 groups: AMI group(n=128) with AMI as the primary cause of death and the rest served as control group(n=343). The pathological features of coronary lesion and related risk factors of AMI were analyzed. Results: In patients aged 60 and over with CAD, 48.8%(230/471) had severe coronary stenosis, 18.7%(88/471) had three-vessel disease, 71.8% cases (338/471) had left anterior descending artery(LAD)grade Ⅲ and over stenosis, 29.9% (141/471) had LAD grade Ⅳ stenosis, 25.9%(122/471) had left main coronary artery(LM) grade Ⅲ and over stenosis, 9.6%(45/471) had LM grade Ⅳ stenosis, 27.1%(128/471) had AMI. The first AMI accounts for 39.1%(50/128), and 60.9%(78/128) had both AMI and old MI. Compared with the control group, AMI group were younger ((77.1±11.6) years vs. (83.2±9.1) years, P<0.01), had more severe coronary artery stenosis lesion (77.3%(99/128) vs. 38.2%(131/343), P<0.01), higher coronary index which reflects the overall arteriosclerosis (9.9±2.8 vs. 8.0±2.5, P<0.01), more three-vessel disease (30.3%(43/128) vs. 13.7%(45/343), P<0.01), heavier heart weight ((447.8±90.6)g vs. (426.6±99.1)g, P<0.05), higher prevlence of pulmonary congestion or edema (57.8%(74/128) vs. 39.9%(137/343), P<0.01). Twenty-three cardiac ruptures (23/128, 18.0%) were observed in AMI group. Logistic regression analysis showed that grade Ⅳ LAD stenosis (OR=3.55, 95%CI 2.05-6.17, P<0.01), three-vessel disease(OR=2.47, 95%CI 1.30-4.67, P<0.01) were the independent risk factors of AMI in elderly patients with CAD. Conclusions: Severe coronary stenosis is common in CAD patients aged 60 and over. Patients aged 60 and over with AMI have more severe coronary artery stenosis lesion and heavier heart weight. Cardiac rupture is not uncommon in elderly patients with AMI. Severe LAD stenosis and three-vessel disease are the independent risk factors of AMI in the elderly.

TCTAP A-074 The Clinical Outcome of Percutaneous Coronary Intervention for Very Elderly Ischemic Coronary Artery Disease Patients in Japan

Our country is a super-aged society and this is an unlike any other in the world. We must consider the treatment strategy for their disease enough. In this study, we examined the clinical outcomes of percutaneous coronary intervention (PCI) for very elderly ischemic coronary artery disease patients

Effect of age on the association between normal thyroid hormone level and coronary artery disease

Objective To investigate the effect of age on the association between normal thyroid hormone level and coronary artery disease (CAD). Methods A total of 1163 euthyroid patients undergoing coronary angiography (CAG) from January 2013 to June 2014 were enrolled and categorized into 2 groups: the young and middle-aged group (<60 years, n=602) and the elderly group (≥60 years, n=561), and each group was sub-grouped into the CAD and non-CAD group according to CAG. Height, body weight, and levels of serum lipid, fasting blood glucose, glycosylated hemoglobin, free triiodothyronine (FT3), free thyroxine (FT4) and thyroid-stimulating hormone (TSH) were measured. Results In the youth and middle-aged group, 309 patients (51.3%) were diagnosed as CAD, and there was no significant difference in the levels of FT3, FT4 and TSH between CAD and non-CAD patients 〔(5.3±0.6)mmol/L vs. (5.3±0.5)mmol/L, (11.8±1.9)mmol/L vs. (11.8±1.8) mmol/L, (2.0±1.1) mIU/L vs. (2.0±1.0)mIU/L, all P>0.05〕. In the elderly group, 357 patients (63.6%) were diagnosed as CAD, and the FT3 level was lower in the CAD patients than in the non-CAD patients〔(5.1±0.6)mmol/L vs. (5.2±0.5)mmol/L, P<0.01〕. Logistic regression demonstrated that FT3 was an independent influencing factor for CAD in elderly patients (OR=0.564, P<0.01). Conclusions The association between normal thyroid hormones levels and CAD varies along with age. Thyroid hormones have no relationships with CAD in the young and middle-aged people. The decline of FT3 level may increase the risk of CAD in the elderly. Key words: Thyroid hormones; Coronary disease; Age factor

Effect of Zhibitai capsule in the treatment of elderly coronary artery disease patients with normal lipid

Objective To explore the effect of Zhibitai capsule in the treatment of elderly coronary artery disease patients with normal lipid, and to investigate its influence on prognosis. Methods 90 elderly coronary artery disease patients with normal lipid were randomly divided into the control group(n= 30),the treatment group 1(n= 30) and the treatment group 2(n= 30). The control group received routine treatment, once a day for 2 months. The treatment group 1 received the Xuezhikang capsule, once a day for 2 months. The treatment group 2 received the Zhibitai capsule, once a day for 2 months. The expression of inflammatory factors, the level of blood fat, the maintenance rate of sinus rhythm and the incidence rate of embolism before and after treatment were compared among the three groups. Results After treatment,the levels of hs- CRP,IL- 6,TNF-α,TC,TG,LDL- C of the three groups were significantly lower than those before treatment(P< 0.05),and the level of HDL- C was significantly higher than before treatment(P<0.05).The levels of hs- CRP,IL- 6,TNF-α,TC,TG,LDL- Cin the treatment group 2 were significantly lower and the level of HDL- C was significantly higher than the other two goups(P< 0.05). Moreover, the differences between the control group and the treatment group 1 were not statistically significant. The maintenance rate of sinus rhythm of the treatment group 2 was significantly higher and the incidence rate of embolism was significantly lower than the treatment group 1. Conclusion For elderly coronary artery disease patients with normal lipid, the Zhibitai capsule has ideal effect in controlling inflammation, which can delay the progress of atherosclerosis, decrease the major cardiovascular events and better than the Xuezhikang capsule. Key words: Zhibitai capsule; Elderly; Coronary artery disease; Clinical research

Estimating exercise capacity from walking tests in elderly individuals with stable coronary artery disease

Purpose: Compared with symptom-limited cardiopulmonary exercise test (CPET), timed walking tests are cheaper, well-tolerated and simpler alternative for assessing exercise capacity in coronary artery disease (CAD) patients. We developed multivariate models for predicting peak oxygen consumption (VO2peak) from 6-minute walk test (6MWT) distance and peak shuttle walk speed for elderly stable CAD patients. Methods: Fifty-eight CAD patients (72 SD 6 years, 66% men) completed: (1) CPET with expired gas analysis on a cycle ergometer, (2) incremental 10-meter shuttle walk test, (3) two 6MWTs, (4) anthropometric assessment and (5) 30-second chair stands. Linear regression models were developed for estimating VO2peak from 6MWT distance and peak shuttle walk speed as well as demographic, anthropometric and functional variables. Results: Measured VO2peak was significantly related to 6MWT distance (r = 0.719, p < 0.001) and peak shuttle walk speed (r = 0.717, p < 0.001). The addition of demographic (age, gender), anthropometric (height, weight, body mass index, body composition) and functional characteristics (30-second chair stands) increased the accuracy of predicting VO2peak from both 6MWT distance and peak shuttle walk speed (from 51% to 73% of VO2peak variance explained). Conclusions: Addition of demographic, anthropometric and functional characteristics improves the accuracy of VO2peak estimate based on walking tests in elderly individuals with stable CAD.Implications for RehabilitationTimed walking tests are cheaper, well-tolerated and simpler alternative for assessing exercise capacity in cardiac patients.Walking tests could be used to assess individual’s functional capacity and response to therapeutic interventions when symptom-limited cardiopulmonary exercise testing is not practical or not necessary for clinical reasons.Addition of demographic, anthropometric and functional characteristics improves the accuracy of peak oxygen consumption estimate based on 6-minute walk test distance and peak shuttle walk speed in elderly patients with coronary artery disease.

TCT-49 A Comparison of 5 mg Prasugrel With 75 mg Clopidogrel in Very Elderly Coronary Artery Disease Patients: Pharmacodynamics and Rates of High on-Treatment Reactivity

A Comparison of 5 mg Prasugrel With 75 mg Clopidogrel in Very Elderly Coronary Artery Disease Patients : Pharmacodynamics and Rates of High on-Treatment Reactivity

Risk Stratification in Elderly Coronary Artery Disease Patients: Can We Predict Which Seniors Benefit Most from Revascularization Options?

With the increased global burden of an aging population manifesting cardiovascular disease, the decision process for use of coronary revascularization options in older adults has gained attention. Assessment of physiologic status has greater bearing than chronologic age; items that have proven of particular merit in evaluating comorbidities as they relate to treatment prognosis for both PCI and CABG in older adults include EuroSCORE and frailty scoring. Evaluation of neurocognitive function can uncover the presence and severity of all-cause dementia, which may be missed in simple medical history interaction. These data have significance when considering aggressive coronary artery disease treatments in this population for symptomatic and/or survival benefit, particularly when high priority is placed on quality of life and independent living post-treatment. Recovery after procedural intervention is slower and with increased morbidity in older adults. Older adults tend to have more complex coronary artery disease; for some, the risk/benefit of revascularization may be prohibitive. Proper selection by the cardiac team for appropriateness of treatment options for each patient’s circumstances can result in excellent percutaneous coronary intervention and coronary artery bypass graft revascularization outcomes, even in the older adult.

263 Mediterranean diet decrease homocysteine levels and increase thiolactonase activities in elderly patients at high risk of cardiovascular disease

Food items might have a synergistic and antagonistic effect on health. The Mediterranean diet (MD) has long been associated with lower incidence of cardiovascular disease and cancer. Elevated blood homocysteine is a risk factor for cardiovascular disease. A 5-mmol/L increase is associated with an approximately 70% increase in relative risk of cardiovascular disease in adults. For patients with established risk factors, this risk is likely even greater. Thiolactonase; the antioxidant enzymatic component of HDL plays a crucial role in metabolizing homocysteine thiolactone and reducing homocysteine endothelial damages. A total of 53 elderly coronary artery disease patient swere recruited and divided into diabetic patient (n = 27; age = 68.3 years) and non diabetics (n = 26; age = 68.7 years). We evaluated plasma homocysteine levels (tHcy); thiolactonase activity (HTase) and studied the effects of adherence to a Mediterranean diet on them. Plasmatic tHcy was determined by capillaryGC-MS; HTLase activity was estimated by a kit immunoassay. Dietary intakes were evaluated by a validated food frequency questionnaire and transformed into a score traducing adherence to MD. Significantly higher median tHcy levels were found in diabetic patients as compared to the non diabetic ones (18.5 μmol/L vs. 5.8; p = 0.057) associated to lower HTase activities (266.8U/L vs. 327.4; p = 0.058). Moreover, in the diabetic patients tHcy levels were negatively associated with thiolactonase activities (r= −0.637; p 0.00). In this group, MD reduced diastolic blood pressure (r= −0.558; p = 0.014). In the non diabetic group, tHcy levels were negatively correlated with HTase activities (r = 0.759; p = 0.00) and diet score (r = −0.0706; p = 0.013) while HTase activities were positively correlated with diet score (r = 0.0759; p = 0.00). Elevated homocysteine in diabetic patients may partly be explained by the diminished thiolactonase activities and could be considered as an additional risk factor for cardiovascular events. Adherence to MD could be the first efficient step to prevent these complications.

Hemodynamics in Elderly Coronary Artery Disease Patients Undergoing Propofol Sedation

The purpose of this study was to evaluate noninvasive intraoperative hemodynamics in an elderly population with coronary artery disease (CAD) undergoing midazolam/fentanyl intravenous sedation-analgesia, with or without propofol for dentoalveolar surgery. A retrospective chart analysis of 24 consecutive male patients aged 60 years or greater, with coronary artery disease, undergoing midazolam/fentanyl intravenous sedation-analgesia with or without propofol for dentoalveolar surgery. Data recorded included noninvasive baseline and intraoperative hemodynamic measurements at 5-minute intervals for systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), pulse pressure (PP), and pulse (P). The addition of propofol to elderly CAD patients resulted in statistically significant lower averages for SBP (126.1 mm Hg vs 131.3 mm Hg, P < .01), DBP (64.1 mm Hg vs 74.3 mm Hg, P < .001), MAP (84.3 mm Hg vs 94.2 mm Hg, P < .001) and PP (57.7 mm Hg vs 61.8 mm Hg, P = .01) with statistically insignificant differences in pulse (74.2 beats per minute vs 75.8 beats per minute, P = .1). Baseline changes in elderly CAD patients who received propofol were within +/-20% (range: -13.8% to +6.9%). Midazolam/fentanyl intravenous sedation provided stable intraoperative hemodynamics in elderly CAD patients. The addition of propofol to elderly CAD patients also resulted in stable intraoperative hemodynamics and may be a safe adjunct to intravenous sedation in elderly CAD patients.

Differences in appraisal and coping between elderly coronary artery disease patients high and low in depressive symptoms

Coronary artery disease (CAD) is frequently found in the elderly and many CAD patients present depressive symptoms. The purpose of this study was to determine if elderly CAD patients high and low in depressive symptoms differ on how they appraise stressors associated with angina pectoris and how they cope with these stressors. Twenty elderly CAD patients high in depressive symptoms and 35 elderly CAD patients low in depressive symptoms identified their most severe chronic stressor attributed to angina and reported their appraisal and coping in relation with this stressor. Groups did not differ on sociodemographic, health-related or stressor-related characteristics. Compared with CAD patients low in depressive symptoms, CAD patients high in depressive symptoms reported appraisal of more harm to their own physical well-being and more threat to their self-esteem and a loved one's well-being. CAD patients high in depressive symptoms also reported using more escape-avoidance coping. These results suggest that ...

PTCA in the Elderly: The “Young‐Old” versus the “Old‐Old”

To evaluate the use of percutaneous transluminal coronary angioplasty (PTCA) in elderly coronary artery disease (CAD) patients. A prospective study of patients 60 years and older undergoing de novo PTCA. We analyze patient risk factors, underlying disease, and clinical outcomes, with at least 3-year follow-up. Comparisons between different age strata among these patients are made to clarify differences between the young old (60 to 69 years), the middle old (70 to 79 years), and the very old (80 years and older). Beth Israel Hospital, Boston, both a primary care and tertiary care teaching hospital. 907 consecutive elderly cardiac patients referred for PTCA are studied. PTCA's were completed using the newest catheter technologies as they became available. All patients were premedicated with aspirin and dipyridamole, and all were anticoagulated with heparin. Subdivision by age demonstrates that the majority (67%) of patients aged 60 to 69 were males, but females were preponderant (61%) in those aged 80 and older. Octogenarians also had lower incidence of hypercholesterolemia, tobacco use, and family history of CAD, and a higher frequency of CHF, angina, and previous MI. Although total procedure-complications increased with age, critical complications (MI, reocclusion, CABG, death) did not. Primary procedural success was similar in all age strata, but older patients had a higher prevalence of multi-vessel disease and longer hospital stay. Follow-up shows that most patients did well after PTCA; there was no increase in repeat PTCA, CABG, and MI with age. While advanced age is associated with changes in risk and clinical parameters for CAD patients, age alone is not a reasonable criterion to limit the use of PTCA.