Long-term outcome of coronary angioplasty in elderly patients with post-infarction angina

The long-term clinical and angiographic outcome of 76 elderly (≤65 years) patients undergoing coronary angioplasty (PTCA) (83 lesions attempted) for post-infarction angina (PIA) (group I) was compared with that of 83 elderly patients undergoing PTCA (105 lesions) for stable angina (group II). Age (70 ± 4 years), gender (70% male) and major demographic variables were similar in both groups. The mean left ventricular ejection fraction was 56 ± 14% in group I vs 67 ± 14% in group II (P<0·01). In group I, PTCA was performed more frequently for lesions located in the right coronary artery (35% vs 18%, P<0·01) and less frequently in the left circumflex artery (12% vs 26%, P<0·05). Although the percentage of lesions with thrombi was higher in group I (16% vs 2%, P<0·0O1), the rate of angiographic success was similar in both groups: 94% (78/83 lesions) in group I vs 93% (98/105) in group II (ns). PTCA was successful in 67 patients (88%) in group I and in 74 (89%) in group II (ns). The rate of major complications was also similar in both groups (4%). Restenosis occurred in 36% vs 31% of the lesions in groups I and II respectively (mean time to angiographic follow-up 7 ±2 months) (proportion of cases with a repeat angiography: 79%in group I and 72% in group II). Restenosis was asymptomatic in 57% vs 50% of the patients respectively. Actuarial event-free survival (freedom from death, acute myocardial infarction, coronary surgery, or repeat angioplasty) after successful PTCA (mean follow-up 22 ± 17 months) was 93%, 84%, 71%, and 54% at 1, 2, 3, and 4 years respectively in group I versus 90%, 80%, 74%, and 56% in group II patients (ns). At last follow-up, 92% vs 93% of our patients were still alive, and 85% vs 75% were asymptomatic (ns). In conclusion, the clinical indication (PIA versus stable angina) does not seem to affect the short term results of PTCA in elderly patients. Moreover, after a successful PTCA, elderly patients with PIA appear to have as a good mid-term outcome as those undergoing PTCA for stable angina.