Evaluation of coronary ancioplasty with autoperfusion catheter in patients aged 65 years or older

Arch. Gerontol. 0167-4943/96/$15.00

Geriatr. 0

EVALUATION

OF

IN

PATIENTS

AGED

T.

GRAVINA,

F.

and

R.

MATTACE

Department Materdomini,

of

suppl. 5 (19961 1996 Elsevier

CORONARY

197-200 Science

ANCIOPLASTY

65 YEARS

OR

and of

Ltd. All rights WITH

197

reserved

AUTOPERFUSION

CATHETER

OLDER

MATTACE-RASO,

Clinical University

Ireland

R.

CALCATERRA,

Experimental Catanzaro,

Via

A.

CREMONESI

Medicine, Chair T. Campanella,

of 88,

Geriatrics, I-88100

Policlinico Catanzaro,

Italy SUMMARY In the period July 1991 - December 1994, 120 consecutive patients underpercutaneous transluminal coronary angioplasty (PTCA); 79 % were males age 70.0 + 5.4 years) and 21 8 females (mean age: 71.0 + 6.8 years). Pahave been-divided into two groups: (i) Group A (67 patients), undergone PTCA with prolonged insufflations (longer than 20 minutes) with autoperfusion catheters (RX perfusion) ; and (ii) Group B (53 subjects) has been treated without autoperfusion catheters. The results show that maintenance of myocardial perfusion during angioplasty permits to increase the duration of inflations and to reduce the frequency and the extension of myocardial damages, both transmural and subendocardial. Therefore, the use of autoperfusion catheter can be recommended as a method of choice in selected lesions such as proximal traits of the left anterior descending coronary artery and the circumflex, ostial lesions of anterior descending artery, circumflex, of the right coronary artery or in PTCA of high risk in vessels with a diameter larger than 2.5 mm.

went (mean tients

Keywords: catheter,

percutaneous coronary

transluminal angioplasty

coronary in

angioplasty

(PTCA)

, autoperfusion

elderly

INTRODUCTION The ment to

percutaneous

of a

transluminal

coronary

artery

younger

tions

because

ostial

lesions,

population. of

al.,

of

1991).

The

whose

degree

tension

of

the

(Ovize

et

al.,

necessary fogy the

elderly is

of

fusion

may

grade

hemoperfusion

be

the

a

patients.

perfusional

maintained

Among by

using

a the

the

a

underlying

new

flow an

coronary

ballon

system of

with

a

tempo-

(Thompson transmural

the ischemic

adequate

surgical support” coronary

active

or ballon

exarea

protection

of

hematic

et ischemia

the

circulation;

prolonged

and

1992). causes

of

techniques with

application

al.,

myocardium,

collateral

“angioplasty for

complica-

inflation is

Therefore, the

frequent

PTCA ballon

occlusion the

the

1993).

support by

permitting

the of

and

al.,

represented

the

of

jeopardy et

et

techniques,

treat-

compared

calcifications

(Myler

during

conditions

at

more

the

patients

disease,

dysfunction

artery

Koning

the

presence

ventricular

in

elderly

are

coronary

consequence on

(PTCA), in

there

diffuse

revascularization

myocardium

method

successful

patients, of

coronary

immediate

1992;

angioplasty

less

elderly

left

other

the

depends

in a new

as

from

occlusion

is

presence

well

Differently rary

In

the

as

coronary

stenosis

passive inflation

is cardiomeaning perretrotime,

198 reaching

this

ischemia

(Wynsen

ing

angioplasty,

by

Turi

180

al.

PATIENTS

in

120

patients pool,

71

+ 6.8

ballon

8 patients

flex

artery Right

90) of

patients

(18 (54

guidewires Catheters was

performed

of (i)

and

(up

60

et

to

ml/min,

al.,

1988).

catheter

December

and

21

into

In

females

2 groups:

was

on

1994.

8 were

(longer

of

Group than

treated

A

20

min)

without

Group

B.

B.

was acid

au-

were

by

“6 using

of

B.

“a) of

(iv)

5 patients

patients

1 patient

%)

of

in

in

11 patients

41

(62

A)

and

8)

Group

B. (6

(1.8

Group “a) of

54 pacircum-

3 patients

Group

of (17

12

cau-

in Left

90) of and

in

(21

B

A

in

B.

[ii)

(10

Group

saphena

patients

Other

Group

B.

or

angina

artery

Group

%) of

18

Stable

Group

patients

%)

of

A

and

10

A

and

29

Group

A and

B.

and

(Group

calcium U of

procedure

in

continuous

4 hrs French the

Rx

channel

heparin

the

removed

type

C

in

(iii)

(12

29

Symptomatic

descending

8)

vena

15

Type

%) of

A and

Type

(iii)

46 + 8.2

10,000 during

(ii)

B.

%) of Group

(84

in

[ii)

infarction

anterior

(10.7

in

6.

B.

6 patients

the

A

angina

Group

Group (14

Group

was

Unstable of

of

left

7 patients

used

Group Group

(i)

myocardial

A and

Type

administered

of

1991

patients)

%)

8)

The

%) of in

graft

fraction

was

and

ballon

inflation

(53

7 patients

Group

(7.1

were:

subsequently

Heparin

time

10 min

[Turi

autoperfusion July

acute (34

45 patients

patient

angioplasty;

and

(40

A and

no

Acetylsalycylic before

were:

(i)

the

(28

PTCA

were:

B;

%)

Ejection

the

B

after

%) of

artery

90) of

14 patients

inflation

than 30

durdeveloped

ballon

between

prolonged

patients

A and

Group

lesions

patients

with

18 patients

5 patients

A and The

protection

more

70 -+ 5.4 years) were divided

patients

of 22

Group

coronary

Group

Group

use

treated

%) of in

of

Group

stenosis

(12.5

vessels

(iii)

The

A and

%) of

(80.3

transmural

catheter

the

for

ischemia

between

PTCA

and

A,

residual

(17.9

tients

prolong

varying

the

myocardial ballon

transmural

age

catheter.

the

Group

%) of Group

The

cases

treated

to

for

asymptomatic

in

to

cases

catheter.

Indications

ses

us

flow

(mean

years).

ballon

of

of

alterations

efficiency

males

undergone

%)

the

evaluated,

autoperfusion

patients

of

most

autoperfusion

allows

blood

the

% were

patients)

(26.8

most

methods

is the

hemodynamic

distal

study,

was

toperfusion

the

in

METHODS

79

age

one

method

or a

a random

this

(42.9

This

preventing

Among

used

ischemia

AND

In

by

(1988).

to prevent

by

1991).

most

maintaining

enough

(mean

results

et al.,

causing min),

(67

better

the

et

without

way

keep

infusion

after

the

perfusion

Student’s

blocking

were to

t test.

48 + 7.5 agents

administered

were

next the

used.

administered the

clotting the of

were

BI.

before

activated until

suspension ACS”

(Group

time morning

medical Statistical

treatment 300

sec.

and

the

treatment. analysis

199 RESULTS In

Group

elevation

A,

in

fusion

the

inflation

infarction

grade

was

1.3

vely)

+-

diospecific

In

and

Group

B,

(p of

78.34

+-

MB,

%).

pain

(DBP

et

per-

myocardial 0

SBP,

Serial

ST

Distal

143

to

28.16

and of

car-

aspartate

al.,

1991)

4)

respecti-

+

analysis

dehydrogenase, Hunt

and

score

and SBP

mmHg.

lactate

min,

in

(chest

follows:

16.4

electrophoresis)(

average

score

DBP

revealed

0

89.57

cardiospecific

to

4) follows:

and

78.67

signs

was of

of

Group

B,

the

64

patients

3.2

+

+

ami-

did

DBP

not

(p

(p

(95.5

%)

is

not

min.

%).

and

show

and

mean

before

and

119.17

= 0.018).

+

Serial

taken

ST

Angina

SBP and

samples

damages

patients

2.57

+ 29.50

mmHg in

+ (82.9

0.2.

15.67

difference

3.12

139.63

above

myocardial in

was

43

SBP

listed

effective

time in

was

as

enzymes

indirect

%)

inflation occurred

recorded

= 0.005);

(95.3

ballon

from

were

Angioplasty tients

and

(12.5

pressures as

4.7

thrombosis

value

recorded

kinase by

the

pain

the

PTCA

12.77

electrocardiograms

inflation

mmHg

blood

-+

patients as

mean

were

(creatinine

the

(chest

during

systolic

+

7

21.23

damage.

in

value

in

was

graded

Angina

inflation

determined

myocardial

time

angiographically

patients.

88.32

enzymes

elevation

inflation occurred

all

during DBP

notransferase

sis

in

Diastolic and

mmHg;

ballon

was

3

0.3.

before

-+ 33.4

average

electrocardiograms

during

any

the

4

31.10 analy-

hours

after

= 0.023). of

Group

A

and

in

50

pa-

significant.

DISCUSSION Our

results

oplasty and

to

extension

elderly

of

patients

tricular

patients

with

to

not

reveal

fusion

and

these

areas

with

any

only

enzymes

myocardial

7 cases

in

patients in

the

(12.5

of the

taken

while in

4

in

43

with

B,

(82.9

treated

after

i.e., %).

in Para-

enzymes

conventional

hours

ventreated

Croup

cases

of

left

patients,

cardiospecific patients

with

of

incidence ischemia

or

A

angi-

the

jeopardy

%),

elderly

during

reduce myocardiai

Group

several

treated

samples

to in

occurred

analysis

damage in

and

at

in

technique serial

while

cardiospecific

in

perfusion

time

myocardium

elevation

conventional

myocardial A),

myocardial

damage

of

ST

observations,

of inflation

subendocardial

extensive

occurred

(Group

B),

maintenance balloon

Indeed,

treated

llel

the the

transmural

autoperfusion

with

autoper-

technique F’TCA

did

(Group

displayed

signs

damages.

Our be

that

prolong

dysfunction.

with

of

show

permits

results

demonstrate

recommended

proximal

as

traits

lesions

of

the

artery,

or

in

of

the

left

anterior PTCA

that

treatment

of

the choice

anterior

high

risk

in

of

artery, in

vessels

autoperfusion

patients

descending

descending of

use

artery circumflex with

ballon

with and part diameters

catheter

selected

lesions

the

circumflex,

of larger

the

as ostial

right than

may such

coronary 2.5

mm.

Our and

study

did

autoperfusion

neficial catheter

effects

reveal

of

a

during at

jeopardy

any

prolonged with

studies

left

be

in

reduces

inflations

in

the

the risk

patients

the

necessary

However,

it

ventricular

difference will

inflation.

because

or

significant

Further

prolonged

is advantageous,

myocardium cardium

not balloons.

of with

efficacy to

use ischemia extensive

of

evaluate of

normal the

be-

autoperfusion and

protect

areas

of

the myo-

dysfunction.

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