ACUTE AND LONG-TERM RESULTS OF CORONARY STENTS AND ATHERECTOMY IN WOMEN AND THE ELDERLY

Aim: To determine the efficacy of new coronary interventions in women and the elderly. Patients and methods: We studied 504 patients who underwent a total of 567 procedures, comprising 275 directional coronary atherectomy and 292 Palmaz-Schatz stents over a 2 1/2 year period; 18% were women and 23% were aged greater than or equal to 70 years (elderly). Results: High rates of success were obtained with these procedures in women and the elderly, although the rates were lower in women than in men (89 versus 96%, P=0.005), and similarly lower in the elderly than in younger patients (91 versus 96%, P=0.06). In addition to the lower success rates, there was a higher incidence of procedure-related non-Q myocardial infarction and vascular complications in both the women and the elderly independently. The degree of angiographic restenosis (greater than or equal to 50% diameter stenosis), however, was similar in women (36 versus 28% in men, P=0.22) and in the elderly (28 versus 29% in patients ages <70 years, P=0.8). There were no sex-related differences in survival, late myocardial infarction, or repeat revascularization. In the elderly, although the incidence of repeat revascularization was not increased, there was a decrease in late survival (P<0.001) and an increase in the incidence of late myocardial infarction (P=0.02), probably reflecting the presence of other co-morbid variables. Conclusion: Both directional coronary atherectomy and coronary stenting can be performed safely and effectively in women and the elderly with good long-term clinical results, despite a somewhat lower rate of success and similarly higher rates of acute complications.