Coronary angioplasty for elderly patients with ''high risk'' unstable angina: Short-term outcomes and long-term survival

Objectives. We sought to compare the short- and long-term mortality rates in patients greater than or equal to 70 years old with unstable angina undergoing percutaneous transluminal coronary angioplasty (PTCA) with predicted coronary artery bypass graft surgery (CABG) short-term and U,S, census long-term mortality rates. Background. Coronary angioplasty is an alternative revascularization strategy for patients with medically refractory rest angina and a high risk of adverse outcomes with CABG. Patients greater than or equal to 70 years old are a specific high risk subset, Methods. A total of 131 consecutive patients aged greater than or equal to 70 years with unstable angina underwent PTCA; 82 (62%) of 131 had been refused CABG. Mortality over time was obtained from the Veterans Affairs Beneficiary Index Records Locator Subsystem. Predicted 30-day CABG-associated mortality was obtained from the Veterans Affairs Cardiac Risk Assessment Model. Mortality over time was expressed with Kaplan-Meier curves. Results. The observed 30-day angioplasty survival rate was 87% compared with the predicted surgical 30-day survival rate of 85.5%, In those patients who survived 6 months after angioplasty (84%), their subsequent 1-, 2-, 3-, 4- and 5-year survival rates were comparable to age-matched subjects in the U.S. census. Mortality in certain subsets known to be at very high risk for CABG-for example, patients who had a previous CABG-was not high in this cohort of elderly subjects. The extremely high risk subsets identified in this PTCA cohort (shock, heart failure, pressors required, balloon pump required) were relatively infrequent subsets. Conclusions. For selected elderly patients with unstable angina deemed to be at ''high risk'' or even ''prohibitive risk'' for CABG, PTCA is an alternative revascularization strategy. The long-term mortality of successfully treated elderly patients is comparable to age matched subjects. A prospective, multicenter, randomized trial of CABG versus PTCA, which includes patients greater than or equal to 70 Sears old, is being conducted (Veterans Affairs Cooperative Study 385: AWESOME). (C) 1997 by the American College of Cardiology.