Nonrandomized comparison of coronary artery bypass surgery and percutaneous coronary intervention for the treatment of unprotected left main coronary artery disease in octogenarians.

  • Rodes-Cabau J
  • Deblois J
  • Bertrand O
 et al. 
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Abstract

BACKGROUND: The objective of the present study was to compare the midterm follow-up results of percutaneous coronary intervention (PCI) and coronary bypass graft surgery (CABG) for the treatment of unprotected left main coronary artery disease in octogenarians. METHODS AND RESULTS: A total of 249 consecutive patients > or =80 years of age diagnosed with left main coronary artery disease underwent coronary revascularization in our center between January 2002 and January 2008; 145 patients underwent CABG, and 104 patients had PCI. Major adverse cardiac and cerebrovascular events (MACCE [cardiac death, myocardial infarction, cerebrovascular event, revascularization]) were evaluated at a mean follow-up of 23 +/- 16 months. Patients who underwent PCI were older; had higher creatinine levels, lower ejection fraction, and higher EuroSCORE; and presented more frequently with an acute coronary syndrome. Drug-eluting stents were used in 48% of PCI patients. A propensity score analysis was performed to adjust for baseline differences between the 2 groups. Survival free of cardiac death or myocardial infarction (PCI, 65.4%; CABG, 69.7%) and MACCE-free survival (PCI, 56.7%; CABG, 64.8%) at follow-up were similar between the groups (adjusted hazard ratio for survival free of cardiac death or myocardial infarction, 1.28; 95% CI, 0.64 to 2.56; P=0.47; adjusted hazard ratio for MACCE-free survival, 1.11; 95% CI, 0.59 to 2.0; P=0.73). The EuroSCORE value was an independent predictor of MACCE regardless of the type of revascularization (hazard ratio, 1.17 for each EuroSCORE increase of 1 point; 95% CI, 1.09 to 1.25; P

Author-supplied keywords

  • Aged, 80 and over
  • Angioplasty, Balloon, Coronary
  • Cerebrovascular Disorders
  • Coronary Artery Bypass
  • Coronary Artery Disease
  • Death
  • Drug-Eluting Stents
  • Follow-Up Studies
  • Humans
  • Myocardial Infarction
  • Myocardial Revascularization
  • Survival Analysis
  • adverse effects
  • complications
  • etiology
  • methods
  • mortality
  • surgery
  • therapy

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Authors

  • Josep Rodes-Cabau

  • Jonathan Deblois

  • Olivier F Bertrand

  • Siamak Mohammadi

  • Javier Courtis

  • Eric Larose

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