Risks high for elderly patients receiving angioplasty to fix narrowed heart artery
Research Activities, June 2012, No. 382
Adverse events are common in patients 65 and older who undergo percutaneous coronary intervention (PCI), or angioplasty, to treat the narrowed unprotected left main coronary artery, according to new research from the Agency for Healthcare Research and Quality (AHRQ). PCI is used to treat less than 5 percent of patients with unprotected left main coronary artery stenosis (ULMCA). The treatment typically is reserved for those who are at high risk for coronary artery bypass graft surgery or in high-urgency situations where survival outcomes are poor.
Elderly patients represent 72.6 percent of patients who receive the PCI treatment for ULMCA stenosis. Trend data, however, indicates that the use of this procedure is slowly increasing, and is being used more often for lower-urgency procedures. Poor health outcomes in elderly ULMCA patients are common and are likely influenced by both patient and procedural factors, including the type of stent used. The study showed 40 percent of elderly patients die within the first three years of followup after the procedure.
Researchers concluded that clinical trials are needed to examine the safety and effectiveness of angioplasty in patients with ULMCA disease, with attention to best practices and the generalizability of trial populations. The study was supported by AHRQ (Contract No. 290-05-0032).
More details are in "Characteristics and long-term outcomes of percutaneous revascularization of unprotected left main coronary artery stenosis in the United States," by J. Matthew Brennan, M.D., M.P.H., David Dai, Ph.D., Manesh R. Patel, M.D., and others in the February 14, 2012 issue of the Journal of the American College of Cardiology 59(7), pp. 648-654.