title: Nonrandomized comparison of coronary artery bypass surgery and percutaneous coronary intervention for the treatment of unprotected left main coronary artery disease in octogenarians.
abstract: BACKGROUND
  The objective of the present study was to compare the midterm follow-up results of percutaneous coronary intervention (PCI) and coronary bypass graft surgery (CABG) for the treatment of unprotected left main coronary artery disease in octogenarians.
  
  
  RESULTS
  A total of 249 consecutive patients > or =80 years of age diagnosed with left main coronary artery disease underwent coronary revascularization in our center between January 2002 and January 2008; 145 patients underwent CABG, and 104 patients had PCI. Major adverse cardiac and cerebrovascular events (MACCE [cardiac death, myocardial infarction, cerebrovascular event, revascularization]) were evaluated at a mean follow-up of 23 +/- 16 months. Patients who underwent PCI were older; had higher creatinine levels, lower ejection fraction, and higher EuroSCORE; and presented more frequently with an acute coronary syndrome. Drug-eluting stents were used in 48% of PCI patients. A propensity score analysis was performed to adjust for baseline differences between the 2 groups. Survival free of cardiac death or myocardial infarction (PCI, 65.4%; CABG, 69.7%) and MACCE-free survival (PCI, 56.7%; CABG, 64.8%) at follow-up were similar between the groups (adjusted hazard ratio for survival free of cardiac death or myocardial infarction, 1.28; 95% CI, 0.64 to 2.56; P=0.47; adjusted hazard ratio for MACCE-free survival, 1.11; 95% CI, 0.59 to 2.0; P=0.73). The EuroSCORE value was an independent predictor of MACCE regardless of the type of revascularization (hazard ratio, 1.17 for each EuroSCORE increase of 1 point; 95% CI, 1.09 to 1.25; P<0.0001).
  
  
  CONCLUSIONS
  In this single-center, nonrandomized study, there were no significant differences in cardiac death or myocardial infarction and MACCE between CABG and PCI for the treatment of left main coronary artery disease in octogenarians after a mean follow-up of 2 years. Baseline EuroSCORE was the most important predictor of MACCE regardless of the type of revascularization. Randomized studies comparing both revascularization strategies in this high-risk coronary population are warranted.
authors.affiliation: Department of Cardiology and Cardiac Surgery, Quebec Heart Institute, Laval Hospital, Quebec, Canada. josep.rodes@crhl.ulaval.ca
authors.forename: Josep
authors.initials: J
authors.lastname: Rodés-Cabau
authors.forename: Jonathan
authors.initials: J
authors.lastname: Deblois
authors.forename: Olivier F
authors.initials: OF
authors.lastname: Bertrand
authors.forename: Siamak
authors.initials: S
authors.lastname: Mohammadi
authors.forename: Javier
authors.initials: J
authors.lastname: Courtis
authors.forename: Eric
authors.initials: E
authors.lastname: Larose
authors.forename: François
authors.initials: F
authors.lastname: Dagenais
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Déry
authors.forename: Patrick
authors.initials: P
authors.lastname: Mathieu
authors.forename: Melanie
authors.initials: M
authors.lastname: Rousseau
authors.forename: Gérald
authors.initials: G
authors.lastname: Barbeau
authors.forename: Richard
authors.initials: R
authors.lastname: Baillot
authors.forename: Onil
authors.initials: O
authors.lastname: Gleeton
authors.forename: Jean
authors.initials: J
authors.lastname: Perron
authors.forename: Can M
authors.initials: CM
authors.lastname: Nguyen
authors.forename: Louis
authors.initials: L
authors.lastname: Roy
authors.forename: Daniel
authors.initials: D
authors.lastname: Doyle
authors.forename: Robert
authors.initials: R
authors.lastname: De Larochellière
authors.forename: Peter
authors.initials: P
authors.lastname: Bogaty
authors.forename: Pierre
authors.initials: P
authors.lastname: Voisine
mesh_terms: D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D002561:Cerebrovascular Disorders / Q000209:etiology; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D003324:Coronary Artery Disease / Q000150:complications / Q000401:mortality / Q000601:surgery* / Q000628:therapy; D003643:Death; D054855:Drug-Eluting Stents; D005500:Follow-Up Studies; D006801:Humans; D009203:Myocardial Infarction / Q000209:etiology; D009204:Myocardial Revascularization / Q000379:methods; D016019:Survival Analysis