Clinical and angiographic profile in coronary artery disease: hospital outcome with emphasis on the very elderly

Galon, Micheli Zanotti; Meireles, George César Ximenes; Kreimer, Sérgio; Marchiori, Gilberto Guilherme Ajjar; Favarato, Desidério; Almeida, João Aparecido Pimenta de; Capeline, Lorena Squassante

doi:10.1590/S0066-782X2010005000127

Abstracts

BACKGROUND: Knowing the risk factors and clinical manifestations of coronary artery disease (CAD) allows us to intervene more effectively with a particular population. OBJECTIVE: To identify clinical and angiographic profiles of patients undergoing cardiac catheterization, treated at a tertiary hospital and treated by percutaneous coronary interventions (PCI). METHODS: The study of 1,282 patients who underwent 1,410 cardiac catheterizations, selected from March/2007 to May/2008 from a database in a general hospital for diagnosis of coronary artery disease (CAD). Risk factors, indication for examination, technical details of PCI and in-hospital outcomes were prospectively collected. RESULTS: There were 688 (54.0%) males, mean age 65.4 ± 10.9 years and 20.0% above 75 years age. The most frequent clinical condition was acute coronary syndrome (ACS) without ST-segment elevation (STS) (38.7%). The multi artery CAD occurred in 46.4%, PCI was indicated in 464 patients, 547 target lesions were treated (type B2 or C, 86.0%), and of these, 14.0% treated with drug eluting stents. Among those with AMI with STS, primary PCI was performed in 19.0% of the patients, from these, 77.0% were transferred from the origin hospitals late (late PCI) and had not received prior thrombolytic, and 4.0% had PCI rescue. Angiographic success was achieved in 94.2% of PCIs. Death occurred in 5.6% of patients, with average age of 75.2 ± 10.2 years. CONCLUSION: The prevalence of elderly (20.1% being > 75 years) and male was observed. From the risk factors for CAD, the most common were systemic hypertension and dyslipidemia. There was a predominance of ACS. Age > 75 years old, multiarterial CAD and chronic renal failure were predictors of in-hospital deaths.

Coronary artery disease; aged; heart catheterization; sickness impact profile; risk factors

FUNDAMENTO: Conhecer fatores de risco e manifestações clínicas da doença arterial coronariana (DAC) permite-nos intervir de maneira mais eficaz junto a uma determinada população. OBJETIVO: Identificar perfis clínicos e angiográficos dos pacientes submetidos a cateterismo cardíaco, atendidos em um hospital terciário e tratados por meio de intervenções coronarianas percutâneas (ICP). MÉTODOS: Casuística de 1.282 pacientes submetidos a 1.410 cateterismos cardíacos, selecionados de mar/2007-mai/2008 em um banco de dados de um hospital geral para diagnóstico de doença arterial coronariana (DAC). Fatores de risco, indicação do exame, detalhes técnicos da ICP e desfechos intra-hospitalares foram prospectivamente coletados. RESULTADOS: Foram 688 (54,0%) pacientes do sexo masculino, com média de idade de 65,4 ± 10,9 anos, sendo 20,0% acima dos 75 anos. O quadro clínico confirmado com mais frequência foi o de síndrome coronariana aguda (SCA) sem supradesnivelamento do segmento ST (SST) (38,7%). A DAC multiarterial ocorreu em 46,4%, foi indicada ICP em 464 pacientes, sendo tratadas 547 lesões-alvo (tipo B2 ou C, em 86,0%), sendo destas, 14,0% tratadas com stent farmacológico. Dentre os IAM com SST, ICP primária foi realizada em 19,0% dos pacientes, sendo que, destes, 77,0% foram transferidos dos hospitais de origem tardiamente (ICP tardia) e não receberam trombolítico prévio, e 4,0% realizaram ICP de resgate. Foi obtido sucesso angiográfico em 94,2% das ICPs. Aconteceu óbito em 5,6% dos pacientes, tendo estes uma média de idade de 75,2 ± 10,2 anos. CONCLUSÃO: Observamos predomínio de idosos (estando 20,1% > 75 anos) e do sexo masculino. Dos fatores de risco para DAC, os mais frequentes foram hipertensão arterial sistêmica e dislipidemia. Ocorreu predomínio da SCA. A idade > 75 anos, DAC multiarterial e a insuficiência renal crônica foram os preditores de óbito intra-hospitalar.

Doença da artéria coronária; idoso; cateterismo cardíaco; perfil de impacto da doença; fatores de risco

FUNDAMENTO: Conocer factores de riesgo y manifestaciones clínicas de la enfermedad arterial coronaria (EAC) nos permite intervenir de manera más eficaz en una determinada población. OBJETIVO: Identificar perfiles clínicos y angiográficos de los pacientes sometidos a cateterismo cardíaco, atendidos en un hospital terciario y tratados por medio de intervenciones coronarias percutáneas (ICP). MÉTODOS: Casuística de 1.282 pacientes sometidos a 1.410 cateterismos cardíacos, seleccionados de mar/2007-may/2008 en un banco de datos de un hospital general para diagnóstico de enfermedad arterial coronaria (EAC). Factores de riesgo, indicación del examen, detalles técnicos de la ICP y desenlaces intrahospitalarios fueron prospectivamente colectados. RESULTADOS: Fueron 688 (54,0%) pacientes del sexo masculino, con media de edad de 65,4 ± 10,9 años, siendo 20,0% encima de los 75 años. El cuadro clínico confirmado con más frecuencia fue el de síndrome coronario agudo (SCA) sin supradesnivel del segmento ST (SST) (38,7%). La EAC multiarterial ocurrió en 46,4%, fue indicada ICP en 464 pacientes, siendo tratadas 547 lesiones-blanco (tipo B2 o C, en 86,0%), siendo de éstas, 14,0% tratadas con stent farmacológico. Entre los IAM con SST, ICP primaria fue realizada en 19,0% de los pacientes, siendo que, de éstos, 77,0% fueron transferidos de los hospitales de origen tardíamente (ICP tardía) y no recibieron trombolítico previo, y 4,0% realizaron ICP de rescate. Fue obtenido éxito angiográfico en 94,2% de las ICPs. Sucedió óbito en 5,6% de los pacientes, teniendo éstos una media de edad de 75,2 ± 10,2 años. CONCLUSIÓN: Observamos predominio de añosos (siendo 20,1% > 75 años) y del sexo masculino. De los factores de riesgo para EAC, los más frecuentes fueron hipertensión arterial sistémica y dislipidemia. Ocurrió predominio de la SCA. La edad > 75 años, EAC multiarterial y la insuficiencia renal crónica fueron los predictores de óbito intrahospitalario.

Enfermedad de la arteria coronaria; añoso; cateterismo cardíaco; perfil de impacto de la enfermedad; factores de riesgo

ORIGINAL ARTICLE

^IHospital do Servidor Público Estadual, São Paulo, SP - Brazil

^IIInstituto do Coração - HC/FMUSP, São Paulo, SP - Brazil

Mailing address

ABSTRACT

BACKGROUND: Knowing the risk factors and clinical manifestations of coronary artery disease (CAD) allows us to intervene more effectively with a particular population.

OBJECTIVE: To identify clinical and angiographic profiles of patients undergoing cardiac catheterization, treated at a tertiary hospital and treated by percutaneous coronary interventions (PCI).

METHODS: The study of 1,282 patients who underwent 1,410 cardiac catheterizations, selected from March/2007 to May/2008 from a database in a general hospital for diagnosis of coronary artery disease (CAD). Risk factors, indication for examination, technical details of PCI and in-hospital outcomes were prospectively collected.

RESULTS: There were 688 (54.0%) males, mean age 65.4 ± 10.9 years and 20.0% above 75 years age. The most frequent clinical condition was acute coronary syndrome (ACS) without ST-segment elevation (STS) (38.7%). The multi artery CAD occurred in 46.4%, PCI was indicated in 464 patients, 547 target lesions were treated (type B2 or C, 86.0%), and of these, 14.0% treated with drug eluting stents. Among those with AMI with STS, primary PCI was performed in 19.0% of the patients, from these, 77.0% were transferred from the origin hospitals late (late PCI) and had not received prior thrombolytic, and 4.0% had PCI rescue. Angiographic success was achieved in 94.2% of PCIs. Death occurred in 5.6% of patients, with average age of 75.2 ± 10.2 years.

CONCLUSION: The prevalence of elderly (20.1% being > 75 years) and male was observed. From the risk factors for CAD, the most common were systemic hypertension and dyslipidemia. There was a predominance of ACS. Age > 75 years old, multiarterial CAD and chronic renal failure were predictors of in-hospital deaths.

Key words: Coronary artery disease; aged; heart catheterization; sickness impact profile; risk factors.

Introduction

The prevalence of coronary artery disease (CAD) has been progressively increasing worldwide as a result of increased life expectancy and survival to acute conditions. Facts that are also seen in Brazil¹.

Cardiovascular diseases have significant morbidity and mortality in the elderly. The World Health Organization (WHO) considers elderly in developing countries, those who are 60 years old or older and in developed countries, individuals aged 65 years old or older. In the U.S., the elderly constitute 13.0% of the population, which accounts for 65.0% of hospitalizations for heart disease. About 85.0% of deaths from AMI occur in the elderly population^2,3.

In elderly patients, percutaneous coronary intervention (PCI) is a strategy of revascularization often used^4,5. Observational data of the 90's suggested that elderly patients are a high-risk group for PCI^6,7; progressing to higher mortality rates when compared to younger individuals.

Elderly patients with acute coronary syndrome (ACS) often have different risk profile from non elderly: they have a higher prevalence of arterial hypertension, diabetes mellitus, myocardial infarctation, angina, peripheral vascular disease, cerebral vascular accident (CVA), multi artery disease and heart failure. On the other hand, they have lower cholesterol levels and a lower prevalence of smoking. Generally, the elderly search for medical care later, after the onset of symptoms. In the event of ACS, instead of pain, they frequently have the so-called "ischemic equivalents," such as dyspnea, malaise, confusion, syncope or pulmonary edema. Also in relation to non elderly, the elderly have lower elevation of cardiac enzymes and a higher incidence of ACS without STS⁸. In the patients over 75 years old, the best therapy with betablocker, ASA, anticoagulant and hypolipemiant is the least used, as well as fibrinolytic and revascularization by angioplasty or surgery^9,10.

The aim of this study was to evaluate patients with suspected CAD who underwent cardiac catheterization and PCI with special focus on the population aged 75 years old or more, their baseline clinical characteristics at admission, medical treatment and outcome in hospital.

Methods

Sample selection

Hospital do Servidor Público serves patients from a service network covering the city of São Paulo and 18 Medical Centers of Ambulatory Care (CEAMAS), located in the inner cities of São Paulo state. Currently, Instituto de Assistência Médica ao Servidor Público Estadual (IAMSPE) includes 1,239,287 aggregated people, involving contributors and beneficiaries, and HSPE is reference to highly complex procedures such as cardiac catheterization. Patients over 70 years old were responsible for about 30.0% of admissions in the last seven years. 1,410 cardiac catheterizations were performed in 1,282 patients for clarifying diagnosis of CAD and included consecutively in a database prospectively from March/2007-May/2008, by completing a clinical record used to record information about the baseline clinical characteristics, symptoms at admission, electrocardiographic changes, laboratory tests, medical treatment and in-hospital evolution of patients. To avoid selection bias, exclusion criteria were not applied and all patients who underwent cardiac catheterization for clarification of CAD in this period were included. The study was approved by the Ethics Committee in Research of the Office of Medical Assistance for Public Servants of the State in accordance with the Declaration of Helsinki.

Analyzed characteristics

As per clinical presentation modalities of CAD, patients were characterized as stable angina (SA), ACS without ST-segment elevation (STS), ACS with STS or ischemic equivalent (atypical manifestations of ACS as dyspnea, malaise, confusion, syncope or pulmonary edema). Risk factors for CAD and its comorbidities were documented at the time of catheterization, by completing a questionnaire: diabetes mellitus (if present, the therapeutic regimen in use is specified: Insulin, oral hypoglycemic agents, diet), smoking, history of CAD in the family, cerebrovascular accident (CVA) /transient ischemic attack (TIA), chronic kidney failure (if present, treatment regimen of dialysis or conservative treatment), dyslipidemia, coronary history (if prior AMI, myocardium revascularization or PCI).

The angiographic characteristics such as extent of CAD (characterized by the number of vessels with angiographic lesion over 50.0% - one, two or three-arteries), TIMI flow before PCI (TIMI 0/1, or when there is absence or discrete flow distal to target lesion; TIMI 2, when there is flow distal to target lesion of the entire coronary, delayed, though; TIMI 3, when there is flow distal to target lesion of the entire coronary compatible with normality) and the treated vessel (if native coronary, venous/arterial or vessel graft with restenosis) were documented and analyzed.

Cardiac catheterization and percutaneous coronary intervention

PCIs were performed according to standard methods and guidelines orientations in force^11-13.

Angiographic and procedure success¹¹ was defined as: 1) angiographic: reduction of target stenosis to a stenosis diameter of < 30.0%, with maintenance or restoration of TIMI 3 flow, as assessed by quantitative coronary angiography; 2) procedure: achievement of angiographic success and absence of major clinical complications (death, AMI with STS and emergency myocardial revascularization surgery). The definition of AMI after a procedure takes into account the development of new Q waves and/or elevation of CK-MB (> three times its baseline), with or without associated precordialgia.

The coronary lesions were divided into A, B1, B2 and C¹¹; according to the classification of the American College of Cardiology and American Heart Association. The characteristics of high risk (type C) were: lesion length > 20 mm, massive calcification, excessive tortuosity of proximal segment, target segment with extreme angulation (> 90 degrees), chronic occlusion in blunt tip, inability to protect significant lateral (> 2.5 mm) and stenotic (> 50%) branch, degenerated vein grafts.

In-hospital outcomes

Patients were followed up during hospitalization, with the intent to highlight complications associated with both diagnostic and therapeutic procedures, the latter being more frequent. The complications were categorized as major were death, myocardial infarctation, emergency MR and CVA (loss of neurological function of vascular cause that lasts longer than 24 hours). Minor complications were: access site complications, renal failure secondary to contrast-induced nephropathy (relative increase of 25 to 50.0% or absolute of 0.5 mg/dl of baseline creatinine after contrast exposure), adverse reactions to radiological contrast, TIA (focal neurological deficit of sudden onset lasting less than 24 hours, presumably of vascular origin and confined to one area of the brain, or eye, irrigated by a specific artery)¹⁴.

The medications used during hospitalization were prescribed by the physician in charge, being documented by completing the medical record, emphasizing: fractionated and low molecular weight heparin, tirofiban, ASA, clopidogrel, ticlopidine, nitrate, betablockers, calcium channel blocker, angiotensin converting enzyme inhibitor, nitrate, insulin, oral hypoglycemic agents¹⁵.

2.5. Statistical analysis

A total of 1,282 patients who underwent 1,410 cardiac catheterizations were evaluated for diagnosis clarification of CAD, and therapeutic clarification for treatment of coronary stenosis, according to inclusion and exclusion criteria.

Quantitative variables were presented as means and standard deviations and the absolute and relative frequencies for qualitative variables were calculated.

To compare the associations between clinical and angiographic variables and the occurrence of death, chi-square test or Fisher's exact test were used. The ages were divided into three age groups (< 60 years old, 60-74 years old and > 75 years old).

To compare the distributions of creatinine clearance among patients younger than 75 years old or 75 years old or more nonparametric ANOVA Kruskal-Wallis was used.

To study the clinical and angiographic correlations and death, in a multivariate way, logistic regression model with stepwise variable selection process was used.

The significance level used was 5.0%.

Results

Overview of the study population

In the study period, 1,410 cardiac catheterizations were performed in 1,282 patients for CAD diagnostic clarification. Table 1 outlines the main baseline clinical characteristics of this population. 688 (54.0%) males, mean age of 65.4 years old (± 10.9) and 20.1% above 75 years old. Among the classic risk factors for CAD, the most common were systemic arterial hypertension and dyslipidemia. Diabetes mellitus was present in 31.6% of patients.

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The confirmed clinic condition that triggered the most catheterization was ACS without STS (38.7%). Among AMI with STS, primary PCI was performed in only 19.0%; 77.0% were transferred from origin hospitals late (late PCI) and had not received prior thrombolytic, 4.0% underwent rescue PCI (Chart 1). Among patients who were not referred for primary PCI, only 12.0% of patients received thrombolytic treatment.

Multiartery coronary artery disease occurred in 46.4% of coronariographies, PCI was indicated in 464 patients and 547 treated target lesions (type B2 or C in 86.6%), located mostly in native vessels (94.7%) and treated with stents, 14.6% with drug-eluting stent (Table 2).

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Procedural success was achieved in 94.2% of PCIs. When analyzed by clinical situation, ACS patients without STS and those with STS undergoing angioplasty within the first 12 hours were successful in 97.1%, while patients with ACS with STS treated late (> 24 hours) and who kept clinical evidence of ischemia, such as post-infarctation angina, acute pulmonary edema attributed to ischemia, among other presentations considered by the clinician of the patient as a result of ischemia, were successful in 90.4%. Among patients with stable angina and atypical manifestations of CAD, the procedural success was achieved in 97.2% and 100.0% respectively.

AMI after PCI was observed in 2.8% of patients, among these, one patient with acute thrombosis (first 24 hours after PCI) of eluting stents (Supralimus 2.5 x 39 mm), possibly due to the stent hypoexpansion in a portion of the lesion with severe calcification of the artery. There was no need for emergency MR (Table 3).

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Among patients undergoing coronary angiography, renal failure secondary to contrast-induced nephropathy occurred in 20 patients (1.6%), of which one quarter required dialysis as therapy. Bleeding from the arterial access way occurred in one patient (femoral), requiring blood transfusion. It was not observed pseudoaneurysm at the puncture site and was not observed inferior or superior limb ischemia (in the case of the radial procedure), ischemic or hemorrhagic CVA.

Death after PCI occurred in 5.2%, mean age of 75.2 ± 10.2 years old. The number of vessels affected by severe lesions was associated with in-hospital mortality: one, two, three vessels or left trunk coronary had a mortality rate of 0.54%, 3.33% and 3.41% respectively (p = 0.0005).

The most used drugs by the patients at the time of catheterization (Table 4) were ASA (65.7%) and statin (52.3%). Overall, patients undergoing PCI received dual antiplatelet therapy (ASA and clopidogrel) after the angioplasty (97.3%).

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Hospital stay was longer in patients with clinical symptoms of ACS (13.7 days).

Comparative analysis between patients younger than 75 years old and older than or equal to 75 years old

Patients who are 75 years old or older had creatinine clearance (CrCL) lower than the patients younger than 75 years old (42.06 and 68.18 l/min/1.73m²; respectively, p < 0.00001). In comparison with males, the female patients undergoing cardiac catheterization were older.

Mortality among those over 75 years old was higher than in those under 75 years old (5.0% versus 1%, p = 0.000097), as in previous CRF (5.3% versus 1.3%, p = 0.0028), as seen in Table 5. All deaths were in patients with ACS (with ST = 37.5%; without ST elevation = 62.5%).

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Discussion

The present study is the first report on clinical and angiographic characteristics of the population of servers in the state of São Paulo who underwent cardiac catheterization for clarifying diagnosis of coronary artery disease and therapeutic treatment of coronary stenoses in the Serviço de Hemodinâmica e Cardiologia do Servidor Público Estadual (HSPE) - Francisco Morato de Oliveira (FMO), IAMSPE.

The population served in HSPE-FMO, IAMSPE is characterized by the prevalence of elderly patients and patients over 70 years old account for approximately 30.0% of the admissions information of great importance since such patients are often excluded from clinical trials³⁴. It can also evaluate the use and adherence to the medical therapeutic procedures^{34, 35}. With this record, we describe a specific population, presenting your profile and how it has led to the diagnosis of CAD research and treatment of this clinical entity in light of the recommended guidelines and numerous clinical trials.

According to data from Fundação Seade, the number of elderly people in São Paulo state is 4.3 million and from this total, 1.9 million is composed of persons aged 70 or older (www.seade.org.br ). In 2020, there will be 7.1 million elderly people in São Paulo state, from this total, consisting of 2.9 million people aged 70 or more. Hence, the great importance of epidemiological studies showing prevalence of elderly population.

One of the most important observations was the large number of patients with ACS without ST elevation (38.7%) in a general hospital, a figure comparable to the 40.0% of emergency centers in cardiology¹⁶. The coronary angiography allows the precise identification of the extent and severity of coronary obstructions, complements the prognostic stratification and the identification of the most appropriate treatment (medical, surgical or percutaneous revascularization), regarding the coronary anatomy presented angiographically.

Two strategies emerge for the treatment of these patients: an early invasive strategy, coronariography within 72 hours, and conservative strategy, after 72 hours of hospital admission^17,18. Although there is not unanimity on the best strategy, the most recent evidence supports an early invasive strategy. All these trials support the prescription of the "invasive strategy" because it reduced the mortality and the occurrence of late infarctation such as re-hospitalization due to ACS^18-21.

On this record, we applied the early invasive strategy to identify patients at highest risk, as patients with severe multi artery CAD (23.0%) and stenoses in left coronary trunk (2.0%). Despite this conduct, we observed a delay in the indication for catheterization, and the patient was referred to the hemodynamics frequently only when admitted to the coronary care unit or cardiology ward, after evaluation by a cardiologist. Such conduct is possibly reflected in a longer period of hospitalization.

In patients with ACS with STS, the elapsed time between the onset of pain and coronary recanalization, chemical or mechanical, is the fundamental factor for the benefit of treatment, both immediate and late, considering the relationship with mortality and morbidity in patients treated within 12 hours of onset of pain. Concerning, in relation to patients with such diagnosis transferred from other hospitals, is the fact that they do not receive appropriate reperfusion therapy, either by delay in transferring or no previous administration of thrombolytic therapy (only 19.0% of primary PCI in the first 12 hours and 12.0% of thrombolytic therapy in this record). This fact affected the success rate of the procedure as described in the results, since patients undergoing PCI within the first 12 hours were successful in 97.1% and those who underwent late PCI, 90.4% (PCI was performed, as, according to the clinical condition of patients, there was clinical myocardial ischemia evidence).

Studies have shown that PCI elective prescription for an occluded coronary artery within one to 28 days after the AMI occurrence in stable patients, did not provide any benefit greater than that offered by medical therapy consisting of aspirin, betablockers, angiotensin converting enzyme inhibitors and statins in preserving left ventricular contractile function and new cardiovascular events^22,23.

Literature data have shown the benefits of primary PCI, compared to fibrinolysis. Primary PCI is capable of restoring normal epicardial coronary flow (TIMI grade 3) in more than 90.0% of patients, which is associated with reduced rates of recurrent ischemia and re infarctation, without the risk of severe bleeding complications, such as CBA^24-26.

Groups of patients considered as high risk, such as the elderly, often have an indication of coronary angiography delayed or prevented, in evident contradiction to literature^27,28. This strategy deprives these patients of the possibility of treatment, as they would have greater benefit in early revascularization, reflected in mortality and/or re infarctation rates. This behavior seems to occur in this record, considering the average age of 65.4 years old (± 10.9) of patients undergoing catheterization, being 20.1% aged 75 years or more.

In CSA, the elderly have a higher incidence of complications, which implies the need for more intensive treatment. However, especially for those above 75 years old, often the best therapy, with beta-blockers, ASA, anticoagulant and hypolipemiant is not used^9,29. During in-hospital period, this difference in drug prescription was not observed in this record.

Our study found that among patients undergoing PCI, those aged 75 years old or more had a higher mortality, although the angiographic success was similar for persons under 75 years old. Complications remain more common in older patients, the prevalence of post-procedure renal failure due to contrast-induced nephropathy was consistent with the literature. Mehran et al³⁰ assessed the risk factors for contrast-induced nephropathy, determining a score for stratification of risk for the development of acute renal failure after PCI. Whereas the elderly population has reduced glomerular filtration rate, it is presumed that the contrast-induced nephropathy would occur more often in this group of individuals. Although this event can be anticipated, the related morbidity is still significant, making this risk considered in indicating the procedure. In cases of patients with high probability for contrast-induced nephropathy, prophylactic measures such as hydration, use of low molecular weight contrast and alternative measures, such as hydration and bicarbonate³¹ and acetylcysteine³²; should be considered.

The increased risk of developing acute renal failure has also been reported in patients with chronic renal failure with ACS with STS undergoing early PCI^33,34. In this group of patients, prophylaxis of acute renal failure can be done, and usually it is possible to obtain clinical stability of patients before intervention, unlike patients with ACS with STS who underwent primary PCI, when prior hydration is not possible and the hemodynamic instability is more common. Our record has identified that patients with chronic renal failure had higher in-hospital mortality, despite renal preparation accomplish and avoidance of the early invasive strategy in these patients.

Elderly patients are more often multiarterial disease. The survival time decreases with the involvement of additional vessels, with the involvement of the anterior descending and left ventricular dysfunction^35,36.

Our analysis shows that both younger and elderly patients can benefit from the PCI, with high rates of success, a fact that has also been observed by other authors^37,38. Age can not be considered a limiting factor for percutaneous procedures.

Conclusion

In this population, there is a predominance of elderly, 20.1% above 75 years old and male. Among the risk factors for CAD, the most common ones were systemic arterial hypertension and dyslipidemia. There was a predominance of acute coronary syndrome. Age greater than or equal to 75 years old, multiarterial CAD and chronic renal failure were predictors of in-hospital deaths in patients undergoing PCI.

Patients aged 75 years or more showed clinical/angiographic high-risk and rate of procedural success similar to younger patients, showing that the PCI is a technique safe and effective in this group of patients.

Potential Conflict of Interest

No potential conflict of interest relevant to this article was reported.

Sources of Funding

There were no external funding sources for this study.

Study Association

This article is part of the thesis of master submitted by Micheli Zanotti Galon, from Instituto de Assistência Médica ao Servidor Público Estadual.

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