P5589Medical therapy versus medical and invasive therapies for elderly patients with multivessel coronary artery disease and left ventricular systolic dysfunction

Abstract

Introduction: Coronary artery disease (CAD) has experienced an increasing prevalence in the last decades. Several randomized trials have demonstrated the benefit of revascularization, either percutaneous coronary intervention or coronary artery bypass grafting surgery, over medical treatment, however, elderly people have been systematically excluded from them because of their poor prognosis, especially those whith left ventricular systolic dysfunction. Purpose: The aim of this study was to investigate the benefit of an invasive and medical approach over a medical strategy alone in patients aged 80 years or older with multivessel coronary artery disease and left ventricular systolic dysfunction. Methods: This was a retrospective, observational, cohort study of patients aged 80 years or older who were admitted to our hospital from May 2001 to July 2017 having the diagnosis of 3 vessel and/or left main CAD and left ventricular ejection fraction of 35% or less. The primary endpoint was death for any cause since the therapeutic decision was taken. Results: During a 16-years recruiting period, 93 patients were included. 32 (34%) were allocated to medical treatment and 61 (66%) to medical plus invasive therapies, 45 percutaneous and 16 surgical revascularization. No significant differences were found in the baseline characteristics in both groups, although we noted a higher prevalence of grade 3 chronic renal insufficiency in the medical group. 59 patients (63.4%) died during the two-year follow-up, 27 (84%) in the medical treatment group and 32 (54%) in the invasive group. The survival curves are shown in figure 1. Being evident a late difference in the risk of dying, we applied the log-rank test to appraise differences between curves which provided a significant result (log-rank=5.2, p=0.023). A Cox-proportional regression model was performed to evaluate the influence of treatment on the outcome of our patients. Two hazard ratios are provided, for the time elapsed form inclusion to day 365: HR=1.01 (0.48-2.09), p=0.990 and for the period of time between 365 and 730 days: HR=0,09 (0.02-0.46), p=0.003. Conclusion: In elderly patients with multivessel coronary artery disease and left ventricular systolic disfunction, an invasive approach along with the medical treatment reduces the risk of dying in the mid-term follow-up over medical treatment alone, provided that patients survive at least one year after the performance of the revascularization procedure.