A comparison between coronary artery bypass grafting surgery and drug eluting stent for the treatment of unprotected left main coronary artery disease in elderly patients (aged > or =75 years).
OBJECTIVE
In this study, we compared the clinical outcomes of elderly patients with unprotected left main coronary artery (ULMCA) stenosis treated with either coronary artery bypass grafting (CABG) or drug-eluting stent (DES).


RESULTS
From January 2003 to April 2006, 259 patients with ULMCA stenosis and age > or =75 years underwent coronary revascularization with either CABG or DES. One hundred and sixty-one patients were treated with CABG and 98 with DES. The cumulative unadjusted rates of 2-year mortality were 17% in CABG-treated patients and 18% in those treated with DES (P = 0.71). The adjusted rates of 2-year survival were 85% for CABG-treated patients and 87% for DES-treated patients (P = 0.74). The incidence of 2-year myocardial infarction was 6% in CABG-treated patients and 4% in DES-treated patients (P = 0.11). The incidence of target lesion revascularization (TLR) was 3% in CABG-treated patients and 25% in DES-treated patients (P < 0.0001). In the multivariable analysis, peripheral vascular disease, left ventricular ejection fraction and acute coronary syndrome were independent predictors of 2-year mortality.


CONCLUSIONS
In this study, we could not demonstrate a difference in mortality between CABG-treated patients and those treated with DES. However, the rate of TLR was higher in the DES group.
Palmerini
Tullio
T
Istituto di Cardiologia, Università di Bologna, Policlinico S. Orsola, Via Massarenti 9, 40 138 Bologna, Italy. tulliopalmerini@hotmail.com
Barlocco
Fabio
F
Santarelli
Andrea
A
Bacchi-Reggiani
Letizia
L
Savini
Carlo
C
Baldini
Elisa
E
Alessi
Laura
L
Ruffini
Michele
M
Di Credico
Germano
G
Piovaccari
Giancarlo
G
Di Bartolomeo
Roberto
R
Marzocchi
Antonio
A
Branzi
Angelo
A
De Servi
Stefano
S
D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000401:mortality; D001026:Coronary Artery Bypass / Q000379:methods / Q000401:mortality; D023921:Coronary Stenosis / Q000401:mortality / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D016019:Survival Analysis; D016896:Treatment Outcome