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Nonrandomized comparison of coronary artery bypass surgery and percutaneous coronary intervention for the treatment of unprotected left main coronary artery disease in octogenarians.
Circulation. 2008 Dec 02; 118(23):2374-81.Circ

Abstract

BACKGROUND

The objective of the present study was to compare the midterm follow-up results of percutaneous coronary intervention (PCI) and coronary bypass graft surgery (CABG) for the treatment of unprotected left main coronary artery disease in octogenarians.

METHODS AND RESULTS

A total of 249 consecutive patients > or =80 years of age diagnosed with left main coronary artery disease underwent coronary revascularization in our center between January 2002 and January 2008; 145 patients underwent CABG, and 104 patients had PCI. Major adverse cardiac and cerebrovascular events (MACCE [cardiac death, myocardial infarction, cerebrovascular event, revascularization]) were evaluated at a mean follow-up of 23 +/- 16 months. Patients who underwent PCI were older; had higher creatinine levels, lower ejection fraction, and higher EuroSCORE; and presented more frequently with an acute coronary syndrome. Drug-eluting stents were used in 48% of PCI patients. A propensity score analysis was performed to adjust for baseline differences between the 2 groups. Survival free of cardiac death or myocardial infarction (PCI, 65.4%; CABG, 69.7%) and MACCE-free survival (PCI, 56.7%; CABG, 64.8%) at follow-up were similar between the groups (adjusted hazard ratio for survival free of cardiac death or myocardial infarction, 1.28; 95% CI, 0.64 to 2.56; P=0.47; adjusted hazard ratio for MACCE-free survival, 1.11; 95% CI, 0.59 to 2.0; P=0.73). The EuroSCORE value was an independent predictor of MACCE regardless of the type of revascularization (hazard ratio, 1.17 for each EuroSCORE increase of 1 point; 95% CI, 1.09 to 1.25; P<0.0001).

CONCLUSIONS

In this single-center, nonrandomized study, there were no significant differences in cardiac death or myocardial infarction and MACCE between CABG and PCI for the treatment of left main coronary artery disease in octogenarians after a mean follow-up of 2 years. Baseline EuroSCORE was the most important predictor of MACCE regardless of the type of revascularization. Randomized studies comparing both revascularization strategies in this high-risk coronary population are warranted.

Authors+Show Affiliations

Department of Cardiology and Cardiac Surgery, Quebec Heart Institute, Laval Hospital, Quebec, Canada. josep.rodes@crhl.ulaval.caNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

19029471

Citation

Rodés-Cabau, Josep, et al. "Nonrandomized Comparison of Coronary Artery Bypass Surgery and Percutaneous Coronary Intervention for the Treatment of Unprotected Left Main Coronary Artery Disease in Octogenarians." Circulation, vol. 118, no. 23, 2008, pp. 2374-81.
Rodés-Cabau J, Deblois J, Bertrand OF, et al. Nonrandomized comparison of coronary artery bypass surgery and percutaneous coronary intervention for the treatment of unprotected left main coronary artery disease in octogenarians. Circulation. 2008;118(23):2374-81.
Rodés-Cabau, J., Deblois, J., Bertrand, O. F., Mohammadi, S., Courtis, J., Larose, E., Dagenais, F., Déry, J. P., Mathieu, P., Rousseau, M., Barbeau, G., Baillot, R., Gleeton, O., Perron, J., Nguyen, C. M., Roy, L., Doyle, D., De Larochellière, R., Bogaty, P., & Voisine, P. (2008). Nonrandomized comparison of coronary artery bypass surgery and percutaneous coronary intervention for the treatment of unprotected left main coronary artery disease in octogenarians. Circulation, 118(23), 2374-81. https://doi.org/10.1161/CIRCULATIONAHA.107.727099
Rodés-Cabau J, et al. Nonrandomized Comparison of Coronary Artery Bypass Surgery and Percutaneous Coronary Intervention for the Treatment of Unprotected Left Main Coronary Artery Disease in Octogenarians. Circulation. 2008 Dec 2;118(23):2374-81. PubMed PMID: 19029471.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Nonrandomized comparison of coronary artery bypass surgery and percutaneous coronary intervention for the treatment of unprotected left main coronary artery disease in octogenarians. AU - Rodés-Cabau,Josep, AU - Deblois,Jonathan, AU - Bertrand,Olivier F, AU - Mohammadi,Siamak, AU - Courtis,Javier, AU - Larose,Eric, AU - Dagenais,François, AU - Déry,Jean-Pierre, AU - Mathieu,Patrick, AU - Rousseau,Melanie, AU - Barbeau,Gérald, AU - Baillot,Richard, AU - Gleeton,Onil, AU - Perron,Jean, AU - Nguyen,Can M, AU - Roy,Louis, AU - Doyle,Daniel, AU - De Larochellière,Robert, AU - Bogaty,Peter, AU - Voisine,Pierre, Y1 - 2008/11/24/ PY - 2008/11/26/pubmed PY - 2008/12/18/medline PY - 2008/11/26/entrez SP - 2374 EP - 81 JF - Circulation JO - Circulation VL - 118 IS - 23 N2 - BACKGROUND: The objective of the present study was to compare the midterm follow-up results of percutaneous coronary intervention (PCI) and coronary bypass graft surgery (CABG) for the treatment of unprotected left main coronary artery disease in octogenarians. METHODS AND RESULTS: A total of 249 consecutive patients > or =80 years of age diagnosed with left main coronary artery disease underwent coronary revascularization in our center between January 2002 and January 2008; 145 patients underwent CABG, and 104 patients had PCI. Major adverse cardiac and cerebrovascular events (MACCE [cardiac death, myocardial infarction, cerebrovascular event, revascularization]) were evaluated at a mean follow-up of 23 +/- 16 months. Patients who underwent PCI were older; had higher creatinine levels, lower ejection fraction, and higher EuroSCORE; and presented more frequently with an acute coronary syndrome. Drug-eluting stents were used in 48% of PCI patients. A propensity score analysis was performed to adjust for baseline differences between the 2 groups. Survival free of cardiac death or myocardial infarction (PCI, 65.4%; CABG, 69.7%) and MACCE-free survival (PCI, 56.7%; CABG, 64.8%) at follow-up were similar between the groups (adjusted hazard ratio for survival free of cardiac death or myocardial infarction, 1.28; 95% CI, 0.64 to 2.56; P=0.47; adjusted hazard ratio for MACCE-free survival, 1.11; 95% CI, 0.59 to 2.0; P=0.73). The EuroSCORE value was an independent predictor of MACCE regardless of the type of revascularization (hazard ratio, 1.17 for each EuroSCORE increase of 1 point; 95% CI, 1.09 to 1.25; P<0.0001). CONCLUSIONS: In this single-center, nonrandomized study, there were no significant differences in cardiac death or myocardial infarction and MACCE between CABG and PCI for the treatment of left main coronary artery disease in octogenarians after a mean follow-up of 2 years. Baseline EuroSCORE was the most important predictor of MACCE regardless of the type of revascularization. Randomized studies comparing both revascularization strategies in this high-risk coronary population are warranted. SN - 1524-4539 UR - https://www.unboundmedicine.com/medline/citation/19029471/Nonrandomized_comparison_of_coronary_artery_bypass_surgery_and_percutaneous_coronary_intervention_for_the_treatment_of_unprotected_left_main_coronary_artery_disease_in_octogenarians_ L2 - http://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.107.727099?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -