Abstract 4532: The Fate of Elderly Patients (Age 65 and Older) With Normal to Mildly Abnormal Coronary Arteriograms: A 13-year Median Follow-up Study
Introduction: Normal coronary arteriograms have been associated with good prognosis in a middle aged population. We assessed the hypothesis that elderly patients with this angiographic finding would be less likely to suffer fatal and non-fatal coronary heart events.
Methods: From 11,625 cardiac catheterizations performed at a hospital between 1986 and 1996 we enrolled consecutive patients aged 65 to 88 with normal (NORM) or mildly abnormal i.e. less than 50% narrowing in lumen diameter coronary arteriography (MILD). Excluding patients with valvular heart disease, left ventricular systolic dysfunction or cardiomyopathy the study group was NORM, n=258 and MILD, n=166. Long term outcomes were tracked using the MIDAS database, a NJ state-wide cardiovascular disease registry. Overall mortality and occurrence of fatal and non-fatal coronary heart disease (CHD) events and were monitored at 1, 5, and 10 years. Survival analysis was performed using the Kaplan-Meier method and Cox proportional hazard regression analysis to adjust for covariates.
Results: The average age in the NORM and MILD groups was 70.9±4.7 and 71.6±5.2 (p=0.2). There were more female patients in the NORM group than in the MILD group and (73% vs. 64%, p=0.04). There was no difference in the rates of hypertension (53% vs. 60%), diabetes (15% vs. 17%), or renal disease (0.8% vs. 2%) in NORM and MILD groups respectively. During the entire follow-up period, a total of 100 patients in NORM died (41 CHD deaths, 16%) and 69 in the MILD group died (23 CHD deaths, 14%). The unadjusted CHD death rate at 1, 5 and 10 years was 0%, 2.7%, 8.9% in NORM and 1.8%, 4.8%, 9.0% in the MILD (Log-rank, NS). The adjusted hazard ratios comparing NORM to MILD for CHD death at the same periods were 0.98 (0.80 –1.19), 0.92 (0.75–1.13), 0.93 (0.76 –1.13) all NS, respectively. The rates of hospitalized non-fatal CHD events were not different.
Conclusions: These results provide evidence that elderly pts with documented normal or mildly abnormal coronary arteriography have CHD average death rates comparable to the reported CHD death rate (1.2% per year) for the same-age NJ population. Therefore in the elderly a normal or mildly abnormal coronary arteriogram does not appear to confer protection against future fatal or non-fatal coronary events.