Percutaneous Coronary Angioplasty in the Elderly: Impact on Functional Status and Quality of Life

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The summary below is from the full report titled "Percutaneous Coronary Revascularization in Elderly Patients: Impact on Functional Status and Quality of Life." It is in the 20 June 2000 issue of Annals of Internal Medicine (volume 132, pages 955-958). The authors are T.B. Seto, D.A. Taira, R. Berezin, M.S. Chauhan, D.E. Cutlip, K.K.L. Ho, R.E. Kuntz, and D.J. Cohen.

What is the problem and what is known about it so far?

Coronary artery disease involves blockages in the blood vessels of the heart. Treatment for this disease includes medicines and more invasive treatments, such as bypass surgery or percutaneous revascularization. With percutaneous revascularization, doctors insert small balloons or tunnels (stents) attached to flexible tubes (catheters) into the large blood vessels in the patient's groin and thread them up into the heart. The stent and catheter are passed through the blocked vessels, a process that opens up the vessels. Older patients tend to have more complications from this procedure than younger patients. Little is known, however, about how well older patients who survive the procedure feel afterwards compared to younger patients.

Why did the researchers do this particular study?

To find out about the general health-related quality of life and the heart-related quality of life among patients 70 years of age and older after percutaneous revascularization of the heart.

Who was studied?

The researchers studied 295 people age 70 and older and 1150 patients younger than age 70 who participated in two studies of percutaneous revascularization.

How was the study done?

Patients completed two different questionnaires about the quality of their lives before and 6 and 12 months after revascularization. One questionnaire measured a person's physical and mental health, and the second questionnaire asked specifically about how a person's angina (chest pain) influenced their daily activities and the way they felt about their health.

What did the researchers find?

More older patients (3.7%) than younger patients (1.7%) had a complication of percutaneous revascularization. Six months after the procedure, physical health, mental health, and cardiovascular-specific health improved in similar percentages of the older and the younger patients. Improvements remained similar at 12 months.

What were the limitations of the study?

Because patients who participate in studies are generally healthier than patients who do not, these findings may not apply to all older patients. In addition, this study does not tell us how well older patients who choose medicines or bypass surgery as treatment for their coronary artery disease feel compared with patients who are treated with percutaneous revascularization.

What are the implications of the study?

Many patients 70 years of age or older who undergo percutaneous revascularization can achieve the same degree of improvement in health-related quality of life as patients younger than 70 years. It is unknown whether older persons would fare better or worse with other treatments, such as medicine or bypass surgery.