title: [Treatment of coronary three-vessel disease in patients above 75 years].
abstract: BACKGROUND
  Chronic ischemic heart disease take the first place in cause of death in Germany. The proportion of patients aged 75 years or older amounts more than 80 %. Due to their growing part of population the medical care of older patients becomes increasingly important. In this investigation patients aged ≥ 75 years with coronary three-vessel disease were characterized and various treatment strategies were compared.
  
  
  METHODS
  This analysis was retrospective. The data of patients aged 75 years or older with three-vessel disease diagnosed by coronary angiography at the Klinikum Lippe Detmold between 2005 and 2007 were collected. Depending on the received therapy they were parted in three groups: optimal drug therapy (OMT), interventional - (PCI) and surgical revascularization (CABG). Patient characteristics as well as survival- and MACCE-rates during follow up were ascertained. Subgroup analyzes were performed for acute coronary syndrom (ACS) and stable coronary artery disease( CAD).
  
  
  RESULTS
  The data of 434 patients with an average age of 79 years were documented. 139 (32.0 %) were assigned to the OMT- 189 (43.6 %) to the PCI- and 106 (24.4 %) to the CABG-group. Overall there was no significant difference between the three groups regarding mortality. In the subgroup of patients wit ACS (n = 180) mortality significantly increased in the OMT-group compared to the two invasive therapies (PCI (p = 0.029), CABG (p = 0.045)). The subgroup of patients with stable CAD showed no significant differences in mortality between the three types of therapy.
  
  
  CONCLUSIONS
  Older patients benefit from an interventional or surgical revascularization in the context of ACS. In contrast, in elderly with stable CAD optimal medical therapy provides a reasonable alternative to invasive therapy without increase in mortality.
authors.forename: F
authors.initials: F
authors.lastname: John
authors.forename: T
authors.initials: T
authors.lastname: Aschenbrenner
authors.forename: R
authors.initials: R
authors.lastname: Felgendreher
authors.forename: K
authors.initials: K
authors.lastname: Bramlage
authors.forename: J
authors.initials: J
authors.lastname: Brockmeier
authors.forename: A
authors.initials: A
authors.lastname: Cuneo
authors.forename: D
authors.initials: D
authors.lastname: Härtel
authors.forename: P
authors.initials: P
authors.lastname: Bramlage
authors.forename: U
authors.initials: U
authors.lastname: Tebbe
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures; D003324:Coronary Artery Disease / Q000628:therapy*; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D012189:Retrospective Studies