Surgical myocardial revascularization versus percutaneous coronary intervention with drug-eluting stents in octogenarian patients.
OBJECTIVE
Our goal was to compare the clinical outcomes of octogenarian (or older) patients who are referred for either surgical or percutaneous coronary revascularization.


METHODS
We retrospectively evaluated the outcomes of all patients 80 years of age who had undergone coronary artery bypass grafting (CABG) with an internal mammary artery or had undergone a percutaneous coronary intervention (PCI) with a sirolimus-eluting stent to the left anterior descending artery in our center between May 2002 and December 2006.


RESULTS
Of the 301 patients, 120 underwent a PCI, and 181 underwent CABG. Surgical patients had higher rates of left main disease, triple-vessel disease, peripheral vascular disease, emergent procedures, and previous myocardial infarctions (39.7% versus 3.3% [P = .001], 76.1% versus 28.3% [P = .0001], 19.6% versus 7.5% [P = .004], 15.8% versus 2.5% [P = .0001], and 35.9% versus 25% [P = .04], respectively). CABG patients had a higher early mortality rate (9.9% versus 2.5%, P = .01). There were no differences in 1- and 4-year actuarial survival rates, with rates of 90% and 68%, respectively, for the PCI group and 85% and 71% for the CABG group (P = .85). The rates of actuarial freedom from major adverse cardiac events (MACEs) at 1 and 4 years were 83% and 75%, respectively, for the PCI group, and 86% and 78% for the CABG group (P = .33). The respective rates of freedom from reintervention were 87% and 83% for the PCI group, versus 99% and 97% for the CABG group (P < .001). The 4-year rate of freedom from recurring angina was 58% for the PCI group, versus 88% for CABG patients (P < .001). Revascularization strategy was not a predictor of adverse outcome in a multivariable analysis.


CONCLUSIONS
Octogenarian CABG patients were sicker and experienced a higher rate of early mortality. The 2 strategies had similar rates of late mortality and MACEs, with fewer reinterventions and recurring angina occurring following surgery.
Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel. Mdbengal@gmail.com
Yanai
Y
Ben-Gal
Ariel
A
Finkelstein
Shmuel
S
Banai
Benjamin
B
Medalion
Giora
G
Weisz
Philippe
P
Genereux
Shelly
S
Moshe
Dmitry
D
Pevni
Galit
G
Aviram
Gideon
G
Uretzky
D000369:Aged, 80 and over; D003324:Coronary Artery Disease / Q000401:mortality* / Q000601:surgery*; D054855:Drug-Eluting Stents / Q000706:statistics & numerical data*; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D009204:Myocardial Revascularization / Q000401:mortality*; D062645:Percutaneous Coronary Intervention / Q000401:mortality*; D015995:Prevalence; D018570:Risk Assessment; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome