Is angioplasty safe for an 80-year-old?

Question

Hello doctor,

My mother is over 80 years old and has had four heart attacks. Two occurred in quick succession about a year ago, and two more in the past month. Her heart's pumping capacity is around 35 percent, and her kidney creatinine level is 3.4 mg/dl, though it is now decreasing. She has never had diabetes, but whenever she is hospitalized for a heart attack, her blood sugar levels increase slightly, and the hospital always starts her on insulin.

For the past year and a half, her cardiologist has not recommended any aggressive treatments, such as angiograms or procedures like angioplasty. If we were to proceed with an angiogram followed by treatments like angioplasty or stent placement, would it be safe for her? Would she be able to survive? Should we opt for a traditional angiogram or a CT angiogram followed by angioplasty or stent placement?

Please advise.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concerns.

Although bypass surgery or angioplasty can be performed in older age if the patient's health is promising, the presence of other health issues increases the risk. Since your mother's kidney function is poor, performing an angiogram becomes very risky, as even non-ionic contrast media can be harmful to the kidneys. One option is to have her undergo one or two dialysis sessions first, followed by angiography and angioplasty, with additional dialysis sessions afterward, in close coordination with a skilled nephrologist. If done safely, the next risk to consider is bleeding. After angioplasty, blood-thinning medications are prescribed for an extended period, which can cause bleeding complications in older individuals.

As for bypass surgery, it is a major procedure requiring general anesthesia. While it is not impossible in older age, it depends on the overall health and organ function of the patient. A cardiac anesthetist would fully evaluate her before proceeding with bypass surgery. The third option is to manage her condition with medications only, without any intervention. In my opinion, you should consult a nephrologist to assess whether there is any possibility of kidney function recovery. If not, periprocedural dialysis can be considered.

I hope this helps you.

Thank you.