Coronary angioplasty versus bypass surgery in patients > 70 years old matched for ventricular function.
OBJECTIVE
This study compared the relative risks and benefits of coronary angioplasty and coronary artery bypass graft surgery in patients > 70 years old.


BACKGROUND
Few objective, comparative data exist to guide the clinician in the decision to use bypass surgery or angioplasty in elderly patients.


METHODS
The study was a case-control, retrospective analysis of 195 consecutive patients who underwent bypass surgery in 1987 and 1988 and were compared with a concurrent cohort of 195 coronary angioplasty-treated patients. The groups were matched for left ventricular function, age and gender mix.


RESULTS
The in-hospital morbidity and mortality rates were significantly lower in the coronary angioplasty-treated patients. Mean postprocedural hospital stay was 4.8 and 14.3 days for angioplasty and surgical group patients, respectively (p < 0.001). In-hospital death occurred in 2% of angioplasty-treated patients compared with 9% of surgically treated patients (p = 0.007). Serious in-hospital stroke occurred in no patient in the angioplasty group and in 5% of patients in the surgical group (p < 0.0001). Q wave infarction occurred in 1% of angioplasty-treated patients and 6% of bypass-treated patients (p = 0.01). The 5-year actuarial survival rate was similar in the two groups: 63% in the angioplasty group, 65% in the bypass group (p = NS). However, surgical group patients experienced less recurrent angina, required fewer repeat revascularization procedures and had fewer Q wave infarctions during follow-up compared with angioplasty group patients.


CONCLUSIONS
When performed in patients > 70 years old, angioplasty and coronary bypass surgery result in similar long-term survival rates but otherwise distinctly different clinical courses.
Mid America Heart Institute, St. Luke's Hospital, Kansas City, Missouri.
J H
JH
O'Keefe
M B
MB
Sutton
B D
BD
McCallister
J L
JL
Vacek
J M
JM
Piehler
R W
RW
Ligon
G O
GO
Hartzler
D000206:Actuarial Analysis; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D001026:Coronary Artery Bypass / Q000009:adverse effects; D003327:Coronary Disease / Q000401:mortality / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D012008:Recurrence; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D016277:Ventricular Function, Left