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)

Federico Conrotto, Paolo Scacciatella, Fabrizio D'Ascenzo, Alaide Chieffo, Azeem Latib, Seung Jung Park, Young Hak Kim, Yoshinobu Onuma, Piera Capranzano, Sanda Jegere, Raj Makkar, Igor Palacios, Pawel Buszman, Tarun Chakravarty, Roxana Mehran, Christoph Naber, Ronan Margey, Martin Leon, Jeffrey Moses, Jean FajadetThierry Lefèvre, Marie Claude Morice, Andrejs Erglis, Corrado Tamburino, Ottavio Alfieri, Maurizio D'Amico, Sebastiano Marra, Patrick W. Serruys, Antonio Colombo, Emanuele Meliga

Research output: Contribution to journalArticlepeer-review

16 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)2007-2012
Number of pages6
JournalAmerican Journal of Cardiology
Volume113
Issue number12
DOIs
StatePublished - Jun 15 2014
Externally publishedYes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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