[Therapeutic attitude after coronariography in elderly patients with ischemic heart disease]. / Actitud terapéutica tras la coronariografía en pacientes ancianos con cardiopatía isquémica.

ABSTRACT

INTRODUCTION: The incidence of ischemic heart disease in the elderly is high. These patients are increasing referred for coronariography. OBJECTIVES: Identify factors associated with coronary revascularization in elderly patients. MATERIAL AND METHODS: Retrospective study of 473 patients > or = 75 years who underwent coronariography in relationship with ischemic heart disease. Their clinical-epidemiological characteristics and treatment adopted were analyzed. A multivariate analysis model was used to identify factors associated with revascularization. RESULTS: Mean age was 77.6 +/- 2.8 years; 70.4% were men. A total of 36% smoked, 53% were hypertensive, 33% diabetics and 30% dislipidemic. Thirty one % had multivessel disease and 11% involvement of left coronary trunk. There was evidence of anterior descending artery in 68%. Medical treatment was done in 48.4%, percutaneous revascularization in 41.5% and surgical in 10.1%. Patients with lesions of the anterior descending artery were revascularized in greater proportion 67.7% vs 32.3%; p. 0.001. A logistic regression model was used to identify revascularization predictors, obtaining a direct relationship with the involvement of the anterior descending artery (OR 4.87; 95% CI 2.98-7.94; (p < 0.001) and inverse on with the previous revascularization (OR 0.47; 95% CI 0.26-0.85; p < 0.02), left ventricular dysfunction (OR 0.58; 95% CI 0.39-0.88; p = 0.01) and presence of multivessel disease (OR 0.51; 95% CI 0.31-0.84; p < 0.01). CONCLUSIONS: The elderly subjects with ischemic heart disease who underwent coronariography received revascularizing treatment in somewhat more than 50% of the cases. A direct relationship was found between involvement of the anterior descending artery and performance of revascularizing treatment and an inverse on between previous revascularization, left ventricular dysfunction and presence of multivessel disease.