Long-term survival after surgery versus percutaneous intervention in octogenarians with multivessel coronary disease.
BACKGROUND
There is limited information comparing long-term survival after percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG) in patients aged 80 years and older. We studied the long-term survival of octogenarians with multivessel coronary artery disease undergoing PCI or CABG who might have been candidates for either procedure.


METHODS
We identified 1693 patients, aged 80 to 89, with two-vessel disease (57.6%) or three-vessel disease (42.4%), without left main disease, undergoing a first, nonemergency revascularization from 1992 to 2001. Adjusted hazard ratios (HR) were calculated for CABG versus PCI. Because survival curves for these procedures crossed midway through year 1, results were analyzed separately for the first 6 months and 6 months to 8 years.


RESULTS
PCI was performed in 54.6% of patients with two-vessel disease and 23.7% of those with three-vessel disease. More CABG patients were men (54.7% versus 43.3%). The CABG patients had more peripheral vascular disease (23.1% versus 15.2%) and congestive heart failure (24.5% versus 13.1%) but less renal failure (4.6% versus 9.1%) and fewer prior myocardial infarctions (48.7% versus 53.6%). In-hospital mortality was 3.0% for PCI and 5.9% for CABG (p = 0.005). CABG was associated with poorer survival than PCI during the first 6 months (HR, 1.32; p = 0.135). Survival from 6 months to 8 years was significantly better with CABG for the group as a whole (HR, 0.72; p = 0.005) and for patients with two-vessel disease (HR, 0.68; p = 0.016), and there was a nonsignificant trend for those with three-vessel disease (HR, 0.75; p = 0.177).


CONCLUSIONS
Patients aged 80 years or older with multivessel disease must consider the trade-off between the increased early risks of CABG in return for improved long-term survival.
Department of Cardiothoracic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03756, USA. lawrence.j.dacey@hitchcock.org
Lawrence J
LJ
Dacey
Donald S
DS
Likosky
Thomas J
TJ
Ryan
John F
JF
Robb
Reed D
RD
Quinn
James T
JT
DeVries
Michael J
MJ
Hearne
Bruce J
BJ
Leavitt
Robert F
RF
Dunton
Robert A
RA
Clough
Donato
D
Sisto
Cathy S
CS
Ross
Elaine M
EM
Olmstead
Gerald T
GT
O'Connor
David J
DJ
Malenka
D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000401:mortality*; D001026:Coronary Artery Bypass / Q000401:mortality*; D003327:Coronary Disease / Q000401:mortality / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male