6533b7d0fe1ef96bd125b7e1
RESEARCH PRODUCT
Long-term outcomes of percutaneous coronary interventions or coronary artery bypass grafting for left main coronary artery disease in octogenarians (from a Drug-Eluting stent for LefT main Artery registry substudy).
Martin B. LeonChristoph NaberTarun ChakravartyCorrado TamburinoYoshinobu OnumaAntonio ColomboSebastiano MarraJean FajadetMaurizio D'amicoOttavio AlfieriJeffrey W. MosesAlaide ChieffoSanda JegereEmanuele MeligaPatrick W. SerruysThierry LefèvreMarie Claude MoriceYoung-hak KimRonan MargeyRoxana MehranAzeem LatibFabrizio D'ascenzoSeung-jung ParkPaolo ScacciatellaPaweł BuszmanPiera CapranzanoAndrejs ĒRglisFederico ConrottoIgor F. PalaciosRaj Makkarsubject
Malemedicine.medical_treatmentMedizinCoronaryKaplan-Meier EstimateCoronary AngiographyCohort StudiesPostoperative Complications80 and overMyocardial infarctionHospital MortalityRegistriesSurvivorsAngioplasty Balloon CoronaryCoronary Artery BypassAged 80 and overEjection fractionHazard ratioAge FactorsAge Factors; Aged 80 and over; Angioplasty Balloon Coronary; Cohort Studies; Coronary Angiography; Coronary Artery Bypass; Coronary Stenosis; Coronary Vessels; Female; Geriatric Assessment; Hospital Mortality; Humans; Kaplan-Meier Estimate; Male; Percutaneous Coronary Intervention; Postoperative Complications; Prognosis; Propensity Score; Registries; Retrospective Studies; Risk Assessment; Survival Analysis; Survivors; Treatment Outcome; Drug-Eluting Stents; Cardiology and Cardiovascular MedicineDrug-Eluting StentsPrognosisCoronary Vesselssurgical procedures operativeTreatment OutcomeDrug-eluting stentCardiologyFemaleCardiology and Cardiovascular Medicinemedicine.medical_specialtyRevascularizationRisk AssessmentPercutaneous Coronary InterventionInternal medicineAngioplastymedicineHumanscardiovascular diseasesPropensity ScoreGeriatric AssessmentAgedRetrospective Studiesbusiness.industryAngioplastyCoronary StenosisPercutaneous coronary interventionmedicine.diseaseSurvival AnalysisSurgeryConventional PCIbusinessBalloondescription
Percutaneous coronary intervention (PCI) with drug-eluting stents is an accepted alternative to surgery for the treatment of unprotected left main coronary artery (ULMCA) disease, but the long-term outcome in elderly patients is unclear. Aim of our study was to compare the clinical outcomes of octogenarians with ULMCA disease treated either with PCI with drug-eluting stents or coronary artery bypass grafting (CABG). The primary study end point was the composite of death, cerebrovascular accident, and myocardial infarction at follow-up. A total of 304 consecutive patients with ULMCA stenosis treated with PCI or CABG and aged 80 years were selected and analyzed in a large multinational registry. Two hundred eighteen were treated with PCI and 86 with CABG. During the hospitalization, a trend toward a higher mortality rate was reported in PCI-treated patients (3.5% vs 7.3%, p = 0.32). At a median follow-up of 1,088 days, the incidence of the primary end point was similar in the 2 groups (32.6% vs 30.2%, p = 0.69). Incidence of target vessel revascularization at follow-up was higher in PCI-treated patients (10% vs 4.2%, p = 0.05). At multivariate analysis, left ventricular ejection fraction was the only independent predictor of the primary end point (hazard ratio 0.95, 95% confidence interval 0.91 to 0.98, p = 0.001). After adjustment with propensity score, the revascularization strategy was not significantly correlated to the incidence of the primary end point (hazard ratio 0.98, 95% confidence interval 0.57 to 1.71, p = 0.95). In octogenarians, no difference was observed in the occurrence of the primary end point after PCI or CABG for the treatment of ULMCA disease. However, the rate of target vessel revascularization was higher in the PCI group. (C) 2014 Elsevier Inc. All rights reserved.
| year | journal | country | edition | language |
|---|---|---|---|---|
| 2014-01-01 |