Elderly Patients with Late Onset of Coronary Artery Disease: Clinical and Angiographic Findings.

A group of elderly patients who did not clinically manifest coronary artery disease until after the age of 65 years were studied. Clinical and angiographic findings of these older patients were compared to findings of patients who had clinical manifestation of coronary artery disease before age 65. In both groups the most common initial manifestation was acute ischemic chest pain (62% vs 75%, NS). However, only 14 (34%) of the 41 elderly patients with chest pain sustained an acute myocardial infarction, compared to 62 (60%) of the 103 younger patients (P is less than 0.05). In 8% of the elderly patients the initial manifestation was acute heart failure not associated with an acute myocardial infarction; none of the younger patients had heart failure without an associated acute infarction (P is less than 0.002). Two percent of the patients over 65 years of age and 4% of the patients under 65 years sustained out-of-hospital cardiac arrest as the initial manifestation of coronary artery disease (NS). Risk factors were more common in the younger patients, with elevated cholesterol levels noted in 24% of the younger patients as compared to only 12% of the elderly patients (P is less than 0.05). Angiographically, elderly patients more commonly demonstrated multivessel coronary artery disease (68% vs 57%, P is less than 0.02) and left main vessel disease (11% vs 2%, P is less than 0.01). Even though multivessel coronary artery disease was common, the majority of elderly patients had normal left ventricular function, as did the younger patients; only 9% of patients in each age group had left ventricular ejection fractions of less than 35%. Treatment varied between the age groups, with coronary artery bypass surgery performed in 38% of the elderly patients as compared to 25% of the younger patients (P is less than 0.05). Only 3% of the patients in each group died during the acute hospitalization, and approximately 95% of the discharged patients in each group were still alive at 24 months mean follow up. We conclude that even though multivessel disease is usually present, coronary artery disease may be clinically silent until the patient is quite old. Left ventricular function is usually well preserved in these elderly patients, and with therapy their prognosis is excellent.