Coronary artery disease in the octogenarian: angiographic spectrum and suitability for revascularization.

The angiographic findings of 84 consecutive octogenarians presenting with symptoms of coronary artery disease (CAD) were examined to determine the extent of CAD as well as suitability for both coronary artery bypass grafting (CABG) and percutaneous transluminal coronary angioplasty (PTCA). The frequency of 0-, 1-, 2-, and 3-vessel and left main CAD was 7, 14, 21, 57 and 13%, respectively. Based on angiographic criteria, 69 of 78 patients (88%) with significant CAD had suitable coronary anatomy for CABG. Only 24 patients (31%) had coronary anatomy amenable to PTCA. CABG was performed in 19 patients with an operative mortality of 16% and major complication rate of 37%. PTCA was performed in 12 patients with a clinical success rate of 83%, mortality of 8% and major complication rate of 8%. It is concluded that in octogenarians with CAD, cardiac catheterization will often reveal coronary anatomy that is suitable for CABG but less suitable for PTCA. The morbidity and mortality associated with these interventions are high.