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.
Dacey
Lawrence J
LJ
Department of Cardiothoracic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03756, USA. lawrence.j.dacey@hitchcock.org
Likosky
Donald S
DS
Ryan
Thomas J
TJ
Robb
John F
JF
Quinn
Reed D
RD
DeVries
James T
JT
Hearne
Michael J
MJ
Leavitt
Bruce J
BJ
Dunton
Robert F
RF
Clough
Robert A
RA
Sisto
Donato
D
Ross
Cathy S
CS
Olmstead
Elaine M
EM
O'Connor
Gerald T
GT
Malenka
David J
DJ
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