This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Thompson, R. C. Articles by Bailey, K. R. Search for Related Content PubMed PubMed Citation Articles by Thompson, R. C. Articles by Bailey, K. R.

Circulation, Vol 88, 1579-1587, Copyright © 1993 by American Heart Association

ARTICLES

Predicting early and intermediate-term outcome of coronary angioplasty in the elderly

RC Thompson, DR Holmes Jr, BJ Gersh and KR Bailey
Division of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL 32224.

BACKGROUND. Although the technical success rate of coronary angioplasty in the elderly in high, very old patients have increased risk of procedure-related death and late recurrence of severe angina. We proposed to determine baseline variables that predict early and intermediate-term failure of percutaneous transluminal coronary angioplasty (PTCA) in patients more than 65 so we could effectively stratify risk. METHODS AND RESULTS. We studied 982 patients at least 65 years old who had urgent or elective PTCA (1980 through 1990). Follow- up (mean, 25 months) was obtained for all patients. Multiple baseline variables were analyzed with univariate and multivariate logistic regression to select independent ones to fit predictive models for in- hospital death or myocardial infarction (overall rate, 6.3%), total in- hospital adverse outcome (overall rate, 18.7%), cumulative survival free of myocardial infarction (overall rate, 15% at 3 years), and cumulative survival free of late nonfatal myocardial infarction, bypass surgery, repeat PTCA, or recurrent severe angina (overall rate, 47% at 3 years). The most heavily weighted parameter in the probability regression equation for each end point was the number of diseased coronary artery segments with at least 70% stenosis. Advanced age was less important. The number of concomitant medical illnesses was predictive of late outcome but not early in-hospital events. Lowest risk quintile versus highest risk quintile event rate was 2.9% versus 14% for acute myocardial infarction or death and 17.2% versus 29% for cumulative in-hospital events. For posthospital events at 3 years' follow-up, lowest risk quintile death or myocardial infarction rate was 4% versus 33% for highest risk quintile. For cumulative late adverse events at 3 years, the event rate was 28% versus 63% for the highest risk quintile. CONCLUSIONS. These results stratify patients at high and low risk of early and intermediate-term success after PTCA and identify elderly patients in whom PTCA is most appropriate.

This article has been cited by other articles:

				J. L. Anderson, C. D. Adams, E. M. Antman, C. R. Bridges, R. M. Califf, D. E. Casey Jr, W. E. Chavey II, F. M. Fesmire, J. S. Hochman, T. N. Levin, et al. ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction) Developed in Collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons Endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine J. Am. Coll. Cardiol., August 14, 2007; 50(7): e1 - e157. [Full Text] [PDF]

				E. Braunwald, E. M. Antman, J. W. Beasley, R. M. Califf, M. D. Cheitlin, J. S. Hochman, R. H. Jones, D. Kereiakes, J. Kupersmith, T. N. Levin, et al. ACC/AHA guidelines for the management of patients with unstable angina and non-st-segment elevation myocardial infarction: A report of the american college of cardiology/ american heart association task force on practice guidelines (committee on the management of patients with unstable angina) J. Am. Coll. Cardiol., September 1, 2000; 36(3): 970 - 1062. [Full Text] [PDF]

				A. Buffon, G. Liuzzo, L. M. Biasucci, P. Pasqualetti, V. Ramazzotti, A. G. Rebuzzi, F. Crea, and A. Maseri Preprocedural serum levels of C-reactive protein predict early complications and late restenosis after coronary angioplasty J. Am. Coll. Cardiol., November 1, 1999; 34(5): 1512 - 1521. [Abstract] [Full Text] [PDF]

				Th. Budde, M. Haude, H.W. Hopp, S. Kerber, G. Caspari, G. Fassbender, M. Fingerhut, I. Novopashenny, Y. Ogurol, G. Breithardt, et al. A prognostic computer model to individually predict post-procedural complications in interventional cardiology; the INTERVENT Project Eur. Heart J., March 1, 1999; 20(5): 354 - 363. [Abstract] [PDF]