Restenosis after Percutaneous Transluminal Coronary Angioplasty in the Elderly—Risk Factor Analysis—

Abstract

Utilization of percutaneous transluminal coronary angioploasty (PTCA) has dramatically expanded even in the management of elderly patients with coronary artery disease. However, restenosis after successful PTCA remains the major problem limiting the long-term efficacy of the procedure. Reported restenosis rates vary from 25 to 43%. In order to determine the relationship of restenosis to coronary risk factors in the elderly, we analyzed the data in 87 patients who had undergone PTCA and angiography before and 3 to 6 months after PTCA. Of these, 29 patients were 65 years of age or older (elderly group) and 58 were less than 65 years of age (younger group). Restenosis, defined as a luminal narrowing of greater than 50% at follow-up time, was found in 20 of the elderly group (69.0%), and in 26 (44.8%) of younger group (p<0.0001). Total cholesterol, LDL cholesterol, apolipoprotein B (apo B), and the ratio of apoB/apoAl in the elderly group were significantly lower than those in the younger group. HDL cholesterol levels were lower than 40 mg/dl in both groups (not significant). Each group was subdivided into two types; restenosis type and non-restenosis type. There were no significant differences in serum lipid, apolipoprotein, and lipoprotein(a) levels between the 2 subtypes in each group. The degree of coronary atherosclerosis calculated by Gensini’s method, the number of damaged coronary vessels, diabetes mellitus, hypertension, and smoking did not appear to affect the rate of restenosis in either group. This study indicated that age is an important risk factor for coronary restenosis. Age should be considered in the indication of PTCA, even though the initial successful rate of PTCA is high in the elderly, and careful follow-up is necessary. © 1995, The Japan Geriatrics Society. All rights reserved.