Peri-interventionelles Risiko von Herzkatheteruntersuchungen bei ≥ 80-jährigen Patienten

Zusammenfassung

Hintergrund: Aufgrund der gestiegenen Lebenserwartung in den industrialisierten Ländern werden immer mehr Herzkatheteruntersuchungen bei Patienten ≥ 80 Jahren durchgeführt. Über die Häufigkeit von peri-interventionellen Ereignissen ist nur wenig bekannt.

Patienten und Methodik: In unserer Klinik wurden zwischen Januar 1996 und September 2000 bei 1085 Patienten im Alter von ≥80 Jahren (82,6 ± 2,6 Jahre) 1384 Herzkatheteruntersuchungen und Interventionen (3 % der insgesamt 43 517 Herzkatheteruntersuchungen) durchgeführt.

Ergebnisse: 827 Patienten (77 %) hatten signifikante Koronarstenosen. 373 (45 %) dieser Patienten wurden mit Ballonangioplastie/Stentimplantation behandelt, 331 (40 %) erhielten eine aortokoronare Bypassoperation. Während des Krankenhausaufenthaltes starben 31 Patienten, von denen bereits zum Aufnahmezeitpunkt 17 Patienten im kardiogenen Schock waren. Peri-interventionelle Ereignisse einschließlich Gefäßverletzungen an den Punktionsstellen gab es bei 2,1 % der Patienten bei einer diagnostischen Herzkatheteruntersuchung und bei 11,6 % nach perkutaner Intervention.

Folgerung: Die Ergebnisse zeigen, dass auch bei Patienten im Alter von ≥ 80 Jahren sowohl Herzkatheteruntersuchungen als auch Interventionen mit einem vertretbaren Risiko durchgeführt werden können. Diese Untersuchungen sollten dieser Altersgruppe nicht vorenthalten werden.

Summary

Background and objective: Because of the rising life expectancy in the industrialized countries, ever more cardiac catheterizations are performed in patients aged 80 years or older. Little is known about the incidence of peri-interventional events in this age group.

Patients and methods: Between January 1996 and September 2000, a total of 1 085 patients of that age (mean 82.6 2.6 years) underwent cardiac catheterization and intervention (3% of a total of 43517 cardiac catheterizations).

Results: 827 patients (77%) had significant coronary artery stenoses. 373 of them (45%) were treated with balloon angioplasty, with or without stenting, and 331 (40%) underwent aortocoronary bypass procedures. 31 patients died while in hospital, 17 of them having been in cardiogenic shock on admission. Peri-interventional events, including damage to artery at the site of catheter entry occurred in 2.1% of patients undergoing diagnostic cardiac catheterization and in 11.6% in connection with a percutaneous interventional procedure.

Conclusion: Both cardiac catheterization and interventional procedures can be done with a justifiable risk in patients aged 80 years or older. These cardiac investigations/interventions should not be withheld in this group of patients for reasons of age.

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