THE TREATMENT OF CORONARY-ARTERY DISEASE IN THE ELDERLY

被引:7
作者
BACKES, RJ [1 ]
GERSH, BJ [1 ]
机构
[1] MAYO CLIN & MAYO FDN,DIV CARDIOVASC DIS & INTERNAL MED,ROCHESTER,MN 55905
关键词
ELDERLY; CORONARY ARTERY DISEASE; BALLOON DILATATION; BYPASS GRAFTING;
D O I
10.1007/BF03029769
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Changing population demographics dictate that in the next decade physicians will be increasingly faced with treating coronary artery disease in the elderly. Despite this, there is a paucity of data to guide management decisions in this population. Currently, it appears that "low-risk" or mild coronary artery disease can be treated medically so long as appropriate adjustments are made for aging changes in renal function, hepatic metabolism, noncompliance, multisystem disease, etc. Unfortunately, most elderly patients have "high-risk" or severe coronary artery disease. Balloon dilatation can yield excellent results in certain highly selected "high-risk" patients, but its role in the frequently encountered multivessel disease patient is unclear until current studies are completed. Coronary bypass grafting in selected patients clearly prolongs survival, but careful patient selection and meticulous preoperative and postoperative is required. Finally, the importance of issues such as quality of life, function independence, and cost must be addressed in more detail if physicians are to make rational decisions in treating this expanding population.
引用
收藏
页码:449 / 455
页数:7
相关论文
共 47 条
[11]  
Forbes G.B., The adult decline in lean body mass, Am Biol, 48, pp. 161-173, (1976)
[12]  
Vestal R.E., Wood A.J., Shand D.G., Reduced β-adrenoceptor sensitivity in the elderly, Clin Pharmacol Ther, 26, pp. 181-186, (1979)
[13]  
DesForges J.F., Orthostatic hypotension in the elderly, N Engl J Med, 14, pp. 952-957, (1989)
[14]  
Feldman R.D., Limbird L.E., Nadeau J., Roberston D., Wood A.J., Alterations in leukocyte β-receptor affinity with aging, N Engl J Med, 310, pp. 815-819, (1984)
[15]  
Chaitman B.R., Bourassa M.G., David K., Et al., Angiographic prevalence of high risk coronary artery disease in patient subsets (CASS), Circulation, 64, pp. 360-367, (1981)
[16]  
Gersh B.J., Kronmal R.A., Schaff H.V., Et al., Long-term 5-year results of coronary bypass surgery in patients 65 years old or older: A report from the coronary artery surgery study, Circulation, 68, 2, pp. 190-199, (1983)
[17]  
Gersh B.J., Kronmal R.A., Frye R.L., Et al., Coronary arteriography and coronary bypass surgery: Morbidity and mortality in patients ages 65 and older. A report from the Coronary Artery Surgery Study, Circulation, 67, 3, pp. 483-491, (1983)
[18]  
Gersh B.J., Kronmal R.A., Schaff H.V., Et al., Comparison of coronary artery bypass surgery and medical therapy in patients 65 years of age or older. A non-randomized study from the Coronary Artery Surgery Study (CASS) registry, N Engl J Med, 313, pp. 217-224, (1985)
[19]  
Ennabli K., Pelletier L.C., Morbidity and mortality of coronary artery surgery after the age of 70 years, Ann Thorac Surg, 42, pp. 197-200, (1986)
[20]  
Horneffer P.J., Gardner T.J., Manolio T.A., Et al., The effects of age on outcome after coronary bypass surgery, Circulation, 76, 5, pp. V6-V12, (1987)