Skip Navigation

This Article
Right arrow FREE Full Text (PDF) Freely available
Right arrow E-letters: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when E-letters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (2)
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Blackman, D. J.
Right arrow Articles by Banning, A. P.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Blackman, D. J.
Right arrow Articles by Banning, A. P.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

Age and Ageing 2003; 32: 129-135
© 2003, British Geriatrics Society

Systematic Review

Revascularisation for acute coronary syndromes in older people

Daniel J. Blackman1, John D. Ferguson1, David C. Sprigings2, and Adrian P. Banning1

1 Department of Cardiology, John Radcliffe Hospital, Oxford, UK
2 Department of Cardiology, Northampton General Hospital, Cliftonville, Northampton NN1 5BD, UK

Abstract

Background: randomised controlled trials have demonstrated that early revascularisation improves outcome in patients with acute coronary syndromes. However, since older people were excluded from these trials, it is not known whether the findings are applicable to them.

Objectives: to evaluate the outcome of revascularisation by percutaneous coronary intervention or coronary artery bypass surgery in older people with acute coronary syndromes. To determine the factors which predict outcome of revascularisation in these patients.

Design: systematic review of studies obtained from the Medline and Embase electronic databases and through bibliographic searches. Analysis by descriptive overview and statistical meta-analysis using pooled proportions.

Included studies: studies published from 1990 onwards describing the outcome of percutaneous coronary intervention or coronary artery bypass surgery in patients >=75 or >=80 years, of whom 75% or more were classified as unstable angina. Studies published from 1990 onwards describing the factors predicting outcome of percutaneous coronary intervention or coronary artery bypass surgery in all patients >=75 or >=80 years.

Results: 26 studies were included. In-hospital mortality from percutaneous coronary intervention was 5.4% (95% confidence interval 3.9% to 7.0%) and after coronary artery bypass surgery was 12.1% (9.5% to 14.7%). Large observational studies indicate expected 30-day mortality of 6–12% with medical treatment. Serious complications following percutaneous coronary intervention were rare, but there was a high rate of major adverse cardiac events over the following year. Major complications, including stroke, were common after coronary artery bypass. However, long-term survival and functional outcome in those who survived the peri-operative period were excellent. Clinical variables predicted those at highest risk from both percutaneous coronary intervention and coronary artery bypass.

Conclusions: percutaneous coronary intervention offers an attractive option for the management of older people with acute coronary syndromes and may improve outcome over conservative treatment. In contrast, coronary artery bypass carries a substantial mortality and morbidity, and is likely to be reserved for patients with refractory symptoms unsuitable for percutaneous intervention. Further data from randomised controlled trials are required.

Keywords: unstable angina, myocardial revascularisation, angioplasty, coronary artery bypass, older people


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?




Disclaimer: Please note that abstracts for content published before 1996 were created through digital scanning and may therefore not exactly replicate the text of the original print issues. All efforts have been made to ensure accuracy, but the Publisher will not be held responsible for any remaining inaccuracies. If you require any further clarification, please contact our Customer Services Department.