title: Coronary artery surgery versus percutaneous coronary intervention in octogenarians: long-term results.
abstract: BACKGROUND
  The aim of this study was to compare 7-year rates of all-cause death, cardiac death, myocardial infarction, target vessel revascularization, and stroke in a large cohort of octogenarians with left main coronary artery or multivessel disease, treated with coronary artery bypass grafting or percutaneous coronary intervention.
  
  
  METHODS
  Two propensity score-matched cohorts of patients undergoing revascularization procedures at regional public and private centers of Emilia-Romagna, Italy, from July 2002 to December 2008 were used to compare long-term outcomes of percutaneous coronary intervention (947 patients) and coronary artery bypass grafting (441 patients).
  
  
  RESULTS
  There were no significant differences between groups in 30-day mortality. In the follow-up the overall and the matched percutaneous coronary intervention population experienced significantly worse outcomes in terms of cardiac mortality, myocardial infarction, and target vessel revascularization. No difference was found for stroke between treatment groups. Percutaneous coronary intervention was an independent predictor of increased death at long-term follow-up. The subgroups in which coronary artery bypass grafting reduced more clearly the risk of death were age 80 to 85 years, previous myocardial infarction, history of cardiac heart failure, chronic renal failure, peripheral vascular disease, and patients with three-vessel disease associated with the left main coronary artery.
  
  
  CONCLUSIONS
  In this real-world setting, surgical coronary revascularization remains the standard of care for patients with left main or multivessel disease. The long-term outcomes of current percutaneous coronary intervention technology in octogenarians are yet to be determined with adequately powered prospective randomized studies.
authors.affiliation: Cardiac Surgery Unit, Clinical and Experimental Medicine Department, University of Parma, Parma, Italy. Electronic address: francesco.nicolini@unipr.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: Nicolini
authors.affiliation: Cardiac Surgery Unit, Cardio-Nephro-Pulmonary Department, Parma Hospital, Parma, Italy.
authors.forename: Giovanni Andrea
authors.initials: GA
authors.lastname: Contini
authors.affiliation: Regional Agency for Health and Social Care, Emilia-Romagna Region, Bologna, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Fortuna
authors.affiliation: Cardio-Thoracic-Vascular Department, University Hospital S. Orsola-Malpighi, Bologna, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Pacini
authors.affiliation: Clinical Surgical Cardiology and Thoracic Vascular Department, Hesperia Hospital, Modena, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Gabbieri
authors.affiliation: Cardiology Unit, Cardio-Nephro-Pulmonary Department, Parma Hospital, Parma, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Vignali
authors.affiliation: Cardiology Department, University Hospital of Ferrara, Ferrara, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Campo
authors.affiliation: Cardiology Department, S. Maria Nuova Hospital, Reggio Emilia, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Manari
authors.affiliation: Department of Cardiology and Cardiac Surgery, Villa Maria Cecilia Hospital, Lugo, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Zussa
authors.affiliation: Regional Agency for Health and Social Care, Emilia-Romagna Region, Bologna, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Guastaroba
authors.affiliation: Regional Agency for Health and Social Care, Emilia-Romagna Region, Bologna, Italy.
authors.forename: Rossana
authors.initials: R
authors.lastname: De Palma
authors.affiliation: Cardiac Surgery Unit, Clinical and Experimental Medicine Department, University of Parma, Parma, Italy.
authors.forename: Tiziano
authors.initials: T
authors.lastname: Gherli
mesh_terms: D000369:Aged, 80 and over; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D062645:Percutaneous Coronary Intervention; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome