title: The effect of age on outcomes of coronary artery bypass surgery compared with balloon angioplasty or bare-metal stent implantation among patients with multivessel coronary disease. A collaborative analysis of individual patient data from 10 randomized trials.
abstract: OBJECTIVE
  This study sought to assess whether patient age modifies the comparative effectiveness of coronary artery bypass graft (CABG) surgery and percutaneous coronary intervention (PCI).
  
  
  BACKGROUND
  Increasingly, CABG and PCI are performed in older patients to treat multivessel disease, but their comparative effectiveness is uncertain.
  
  
  METHODS
  Individual data from 7,812 patients randomized in 1 of 10 clinical trials of CABG or PCI were pooled. Age was analyzed as a continuous variable in the primary analysis and was divided into tertiles for descriptive purposes (≤56.2 years, 56.3 to 65.1 years, ≥65.2 years). The outcomes assessed were death, myocardial infarction and repeat revascularization over complete follow-up, and angina at 1 year.
  
  
  RESULTS
  Older patients were more likely to have hypertension, diabetes, and 3-vessel disease compared with younger patients (p < 0.001 for trend). Over a median follow-up of 5.9 years, the effect of CABG versus PCI on mortality varied according to age (interaction p < 0.01), with adjusted CABG-to-PCI hazard ratios and 95% confidence intervals (CI) of 1.23 (95% CI: 0.95 to 1.59) in the youngest tertile; 0.89 (95% CI: 0.73 to 1.10) in the middle tertile; and 0.79 (95% CI: 0.67 to 0.94) in the oldest tertile. The CABG-to-PCI hazard ratio of less than 1 for patients 59 years of age and older. A similar interaction of age with treatment was present for the composite outcome of death or myocardial infarction. In contrast, patient age did not alter the comparative effectiveness of CABG and PCI on the outcomes of repeat revascularization or angina.
  
  
  CONCLUSIONS
  Patient age modifies the comparative effectiveness of CABG and PCI on hard cardiac events, with CABG favored at older ages and PCI favored at younger ages.
authors.affiliation: University of East Anglia, Norwich, United Kingdom.
authors.forename: Marcus
authors.initials: M
authors.lastname: Flather
authors.forename: June-Wha
authors.initials: JW
authors.lastname: Rhee
authors.forename: Derek B
authors.initials: DB
authors.lastname: Boothroyd
authors.forename: Eric
authors.initials: E
authors.lastname: Boersma
authors.forename: Maria Mori
authors.initials: MM
authors.lastname: Brooks
authors.forename: Didier
authors.initials: D
authors.lastname: Carrié
authors.forename: Tim C
authors.initials: TC
authors.lastname: Clayton
authors.forename: Nicholas
authors.initials: N
authors.lastname: Danchin
authors.forename: Christian W
authors.initials: CW
authors.lastname: Hamm
authors.forename: Whady A
authors.initials: WA
authors.lastname: Hueb
authors.forename: Spencer B
authors.initials: SB
authors.lastname: King
authors.forename: Stuart J
authors.initials: SJ
authors.lastname: Pocock
authors.forename: Alfredo E
authors.initials: AE
authors.lastname: Rodriguez
authors.forename: Patrick
authors.initials: P
authors.lastname: Serruys
authors.forename: Ulrich
authors.initials: U
authors.lastname: Sigwart
authors.forename: Rodney H
authors.initials: RH
authors.lastname: Stables
authors.forename: Mark A
authors.initials: MA
authors.lastname: Hlatky
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D016001:Confidence Intervals; D001026:Coronary Artery Bypass / Q000379:methods*; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D015607:Stents; D015996:Survival Rate / Q000639:trends; D013997:Time Factors