Case 5/2015 – 88-Year-Old Female with Chronic Coronary Artery Disease, Upper Limb Thrombosis, Atrial Fibrillation and Cardiac Arrest

Clinical aspects

The patient is an 88-year-old female, who, because of chest angina, underwent percutaneous angioplasty with stenting, remaining asymptomatic for 13 years. The angina reappeared, and, after a new percutaneous intervention, she died. She underwent seven coronary angiographies, three of which with angioplasty and stenting. The fifth and seventh procedures had complications.

The first point of interest is the indication of intervention therapy with stenting to an elderly patient with chest angina. Published studies support that indication. The results of intervention therapy in patients older than 80 years (n = 983) have shown a four-year survival of 71.6% for stent implantation (n = 289), better than that achieved with isolated drug treatment (n = 561, survival of 60.3%). The good results of the intervention therapy were later confirmed in 79/276 patients (52%) aged 80 ± 4 years, whose four-year survival was 72%. The clinical experience confirms those observations. Thus, in our patient, the percutaneous intervention therapy performed for the first time at the age of 74 years and followed by 13 asymptomatic years was again indicated, when she became symptomatic.

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