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Angioplasty
can be performed successfully even in very elderly patients
with coronary artery disease, according to a study reported
in the August 7th issue of the Journal of the American College
of Cardiology.
Smaller
studies conducted in the past had suggested that very elderly
patients faced a high risk of dying in the hospital during
catheter-based procedures designed to widen narrowed arteries.
Deciding
that a larger study was in order, researchers led by Dr. Lloyd
W. Klein, of Rush-Presbyterian-St. Luke's Medical Center in
Chicago, evaluated data from 8,828 angioplasties performed
on octogenarians at more than 145 participating centers between
1998 and 2000.
The researchers
discovered that the procedure was both effective and safe
for elderly patients. The procedure restored blood flow in
93 percent of the cases, and the overall death rate during
hospitalization was less than four percent.
Not all
octogenarians did as well, however. Patients who underwent
angioplasty within six hours of a heart attack had a tenfold
increase in mortality. When the researchers excluded patients
who had suffered a heart attack within a week of their angioplasty,
the in-hospital mortality rate dropped to just 1.35 percent.
"Our
new findings show that in fact these procedures can be done
in the very elderly with a degree of success almost as high
as that in the nonelderly population," said Klein. "We
hope our findings will help the elderly and their families
understand that, for the most part, the risks aren't as high
as they imagined."
Klein
said the study includes a 254-point mathematical model called
a nomogram that physicians can use to calculate patients'
risks very accurately. "For the elderly patients for
whom the risk is going to be quite high, we hope our findings
will allow them to proceed with a better understanding of
what those risks are," he said.
According
to Dr. Eric R. Bates, of the University of Michigan Health
System, octogenarians are the fastest-growing segment of the
U.S. population and represent almost 10 percent of the percutaneous
coronary intervention procedures such as angioplasty that
are performed.
Source:
Heart
Disease Week of August 11, 2002
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