ORLANDO, Fla. -- Angioplasty can be a safe and effective procedure for heart patients 80 and older, according to researchers from the Duke University Medical Center.
Their research is one of the most detailed studies addressing the short-term outcomes of angioplasty procedures in octogenarians. The findings, prepared for presentation at the annual scientific session of the American Heart Association, show that angioplasties done in high-volume centers by skilled physicians can be good therapy for what ails the elderly heart.
Medications generally have been the favored therapy for these patients, because there have been few previous comprehensive studies assessing the risks and benefits of angioplasty in the elderly, the researchers said. And without proof, many physicians have been reluctant to refer their older patients for the procedure, in which a catheter is threaded into clogged heart arteries and a balloon is expanded to press plaque back.
"The take-home message is that patients this age can do quite well with an angioplasty, given that they are appropriate candidates for the procedure," said Duke cardiologist Dr. Wayne Batchelor. "It's a brighter picture than we thought."
He said the study can help pave the road for more advanced care of elderly cardiac patients. "The U.S. population is aging rapidly. In 2005, more than 30 percent of the population will be over the age of 65, and the fastest-growing segment is those 80 and over," Batchelor said. "From a public health perspective, we have to understand how to deal with aging hearts."
Octogenarians are generally excluded from clinical trials of new drugs and therapies, and the only widespread data collected on their treatment is from the Medicare database, which gives limited information. Studies done in the early 1990s on elderly Medicare patients undergoing angioplasty showed 7 percent mortality, versus the 3.5 percent rate the Duke study found.
To conduct this study, Batchelor and his colleagues looked at the medical records of 3,740 patients age 80 or older who received angioplasties at 19 hospitals across the country between January 1994 and November 1996. These hospitals, both community and academic medical centers, have agreed to collaborate in the National Cardiovascular Network (NCN), in which they submit detailed care and treatment information on heart patients. Duke is the coordinating center for the NCN.
The researchers compared the rate of death, secondary heart attack, stroke, emergency bypass surgery, and other complications between the octogenarians and 58,714 patients younger than 80, and found:
The 3.5 percent mortality in the 80-plus group, which Batchelor called "quite good, given that they have more extensive coronary disease as well as other health issues," adding that it was much better than anticipated. Previous studies using Medicare data found a mortality rate of 7 percent or more. The mortality rate is 1 percent in patients younger than 80.
The rate of heart attacks following angioplasty was almost the same in both groups: 2.1 percent for 80-plus patients compared with 4 percent in the younger group.
The rate of emergency bypass surgery following a failed angioplasty was actually less in the older patients: 1.7 percent versus 2.5 percent in patients less than 80 years old. Batchelor noted that this may be due to a reluctance by physicians to send older patients for operative procedures once angioplasty has failed.
Although strokes (0.75 percent), renal (3 percent) or vascular (5.9 percent) complications occurred significantly more frequently in the 80-plus patients, they were within an acceptable range, the researchers say.
Despite the age of the elderly group, they stayed in the hospital only about a day and one-half longer, generally, than the younger group. The average stay for 80-plus patients was 4 days compared to 3 days for the younger group.
Almost as many of the elderly patients (20 percent) received a stent -- a tiny, a girder-like structure placed in a vessel to keep it open -- as did younger patients (23 percent), and although long-term follow-up information is not yet available, "at a first glance, stented patients old and young did well," said Batchelor.
In the older group, 52 percent of the patients were female, compared to 30 percent in the younger group. The difference is because, historically, men don't live as long as women, he said.
While Batchelor said the study suggested that "the risk in octogenarians undergoing coronary intervention is improving over time," he cautions that these good rates come from hospitals that do "high volume work, with skilled operators." That is, the hospitals perform at least 300 angioplasties yearly. "These are the institutions that are more experienced in performing the procedure," he said. "We don't know what the comparison is in other hospitals."
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