title: Survival after coronary revascularization in the elderly.
abstract: BACKGROUND
  Elderly patients with ischemic heart disease are increasingly referred for coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). However, reports of poor outcomes in the elderly have led to questions about the benefit of these strategies. We studied survival by prescribed treatment (CABG, PCI, or medical therapy) for patients in 3 age categories: <70 years, 70 to 79 years, and > or =80 years of age.
  
  
  RESULTS
  The Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease (APPROACH) is a clinical data collection and outcome monitoring initiative capturing all patients undergoing cardiac catheterization and revascularization in the province of Alberta, Canada, since 1995. Characteristics and long-term outcomes of a cohort of >6000 elderly patients with ischemic heart disease were compared with younger patients. In 15 392 patients >70 years of age, 4-year adjusted actuarial survival rates for CABG, PCI, and medical therapy were 95.0%, 93.8%, and 90.5%, respectively. In 5198 patients 70 to 79 years of age, survival rates were 87.3%, 83.9%, and 79.1%, respectively. In 983 patients > or = 80 years of age, survival was 77.4% for CABG, 71.6% for PCI, and 60.3% for medical therapy. Absolute risk differences in comparison to medical therapy for CABG (17.0%) and PCI (11.3%) were greater for patients > or =80 years of age than for younger patients.
  
  
  CONCLUSIONS
  Elderly patients paradoxically have greater absolute risk reductions associated with surgical or percutaneous revascularization than do younger patients. The combination of these results with a recent randomized trial suggests that the benefits of aggressive revascularization therapies may extend to subsets of patients in older age groups.
authors.affiliation: Department of Medicine, University of Alberta, Canada.
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Graham
authors.forename: William A
authors.initials: WA
authors.lastname: Ghali
authors.forename: Peter D
authors.initials: PD
authors.lastname: Faris
authors.forename: P Diane
authors.initials: PD
authors.lastname: Galbraith
authors.forename: Colleen M
authors.initials: CM
authors.lastname: Norris
authors.forename: Merril L
authors.initials: ML
authors.lastname: Knudtson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D000416:Alberta / Q000453:epidemiology; D015906:Angioplasty, Balloon, Coronary / Q000401:mortality*; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000401:mortality*; D003327:Coronary Disease / Q000453:epidemiology / Q000401:mortality* / Q000628:therapy; D016208:Databases, Factual; D004358:Drug Therapy / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D017202:Myocardial Ischemia / Q000453:epidemiology / Q000401:mortality* / Q000628:therapy; D009204:Myocardial Revascularization / Q000401:mortality*; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D013318:Stroke Volume; D015996:Survival Rate; D016896:Treatment Outcome