Results of direct percutaneous transluminal coronary angioplasty in octogenarians

Direct percutaneous transluminal coronary angioplasty (PTCA) has emerged as effective reperfusion therapy for acute myocardial infarction; however, few data exist on its use in octogenarians, Thrombolytic therapy in this age group has reduced early mortality from approximately 30% to 20%, but is associated with an increased risk of stroke and major hemorrhage. We analyzed the acute and long-term results of direct PTCA performed on patients aged greater than or equal to 80 years at our institution between 1980 and 1993, The study group consisted of 55 patients (mean patient age 83.3 +/- 2.3 years), Infarcts were anterior in 27 patients (49%), Cardiogenic shock was present in 6 patients (11%), The mean time to reperfusion was 4.3 +/- 2.8 hours, Direct PTCA was successful in 53 patients (96%). There were no emergent bypass operations. In-hospital death occurred in 9 patients (16%), including 4 of 6 (67%) presenting in cardiogenic shock and 5 of 49 (10%) who were hemodynamically stable on presentation, Repeat PTCA for recurrent ischemia was performed in 6 patients (11%), There were no strokes during hospitalization, Bleeding complications requiring blood transfusion were present in 4 patients (7%). Thirty-day mortality was 16% and 1-year actuarial survival was 67%. Direct PTCA in patients aged greater than or equal to 80 years can be performed safely with a high procedural success rate. The clinical outcome with PTCA in this high risk subset of patients compares favorably with that reported previously for both thrombolytic and medical therapy.