title: Survival probability loss from percutaneous coronary intervention compared with coronary artery bypass grafting across age groups.
abstract: BACKGROUND
  Whether the survival benefit from coronary artery bypass grafting (CABG), compared with percutaneous coronary intervention (PCI), for multivessel disease extends to the older segment of the population remains unclear. We aimed to investigate whether the effect on survival of PCI compared with CABG is related to the age of the patient.
  
  
  METHODS
  Propensity score-matching analysis was conducted on 6723 patients (PCI = 1097, CABG = 5626) with multivessel coronary artery disease. In the PCI group, drug-eluting stents were used in 917 (83.5%) patients; bare metal stents were used in only 180 patients (16.5%). Nonparametric, bootstrap, point-wise confidence limits were obtained for PCI:CABG odds and hazard ratios for early (within 12 months) and late hazard phase (beyond 12 months) for a variety of age groups.
  
  
  RESULTS
  After a mean follow-up time of 5.5 ± 3.2 years, a total of 301 deaths were recorded in the matched sample (208 in the PCI group and 93 in the CABG group). Overall survival was 95% ± 0.6% versus 95% ± 0.6% at 1 year, 84% ± 1.0% versus 92.4% ± 0.8% at 5 years, and 75% ± 1.6% versus 90% ± 1.0% at 8 years, for the PCI and CABG groups, respectively (log rank P < .001). PCI did not confer any significant benefit compared with CABG during the early hazard phase (within 12 months), but the survival-probability loss from PCI compared with CABG during the late hazard phase was present across all age groups. The hazard ratio declined from 3.8 to 3.4 and was statistically significant (lower limit >1 across all ages, ranging from 1.5 to 2.4).
  
  
  CONCLUSIONS
  Compared with PCI, CABG leads to a significant reduction in late-phase mortality across all age groups.
authors.affiliation: Department of Cardiac Surgery, Harefield Hospital, London, United Kingdom. Electronic address: umberto.benedetto@hotmail.com.
authors.forename: Umberto
authors.initials: U
authors.lastname: Benedetto
authors.affiliation: Department of Cardiac Surgery, Harefield Hospital, London, United Kingdom.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Amrani
authors.affiliation: Department of Cardiac Surgery, Harefield Hospital, London, United Kingdom.
authors.forename: Toufan
authors.initials: T
authors.lastname: Bahrami
authors.affiliation: Department of Cardiac Surgery, Harefield Hospital, London, United Kingdom.
authors.forename: Jullien
authors.initials: J
authors.lastname: Gaer
authors.affiliation: Department of Cardiac Surgery, Harefield Hospital, London, United Kingdom.
authors.forename: Fabio
authors.initials: F
authors.lastname: De Robertis
authors.affiliation: Department of Cardiology, Harefield Hospital, London, United Kingdom.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Smith
authors.affiliation: Department of Cardiac Surgery, Harefield Hospital, London, United Kingdom.
authors.forename: Shahzad G
authors.initials: SG
authors.lastname: Raja
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000401:mortality* / Q000628:therapy*; D006801:Humans; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D011336:Probability; D057216:Propensity Score; D012189:Retrospective Studies; D015607:Stents; D015996:Survival Rate