TY - JOUR
T1 - 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)
AU - Conrotto, Federico
AU - Scacciatella, Paolo
AU - D'Ascenzo, Fabrizio
AU - Chieffo, Alaide
AU - Latib, Azeem
AU - Park, Seung Jung
AU - Kim, Young Hak
AU - Onuma, Yoshinobu
AU - Capranzano, Piera
AU - Jegere, Sanda
AU - Makkar, Raj
AU - Palacios, Igor
AU - Buszman, Pawel
AU - Chakravarty, Tarun
AU - Mehran, Roxana
AU - Naber, Christoph
AU - Margey, Ronan
AU - Leon, Martin
AU - Moses, Jeffrey
AU - Fajadet, Jean
AU - Lefèvre, Thierry
AU - Morice, Marie Claude
AU - Erglis, Andrejs
AU - Tamburino, Corrado
AU - Alfieri, Ottavio
AU - D'Amico, Maurizio
AU - Marra, Sebastiano
AU - Serruys, Patrick W.
AU - Colombo, Antonio
AU - Meliga, Emanuele
N1 - Funding Information:
Dr. Mehran is a consultant to Abbott Vascular (Abbott Park, Illinois), AstraZeneca (London, United Kingdom), Boston Scientific (Natick, Massachusetts), Covidien (Mansfield, Massachusetts), The Medicines Company (Parsippany, New Jersey), Janssen (Johnson and Johnson) (New Brunswick, New Jersey), Regado Biosciences (Basking Ridge, New Jersey), Maya Medical (Campbell, California), and Merck (Whitehouse Station, New Jersey) and has received research grant support from Bristol-Myers Squibb/Sanofi (Paris, France), The Medicines Company , and Lilly/Daiichi Sankyo (Tokyo, Japan). Dr. Naber is a speaker for Abbott Vascular, Cordis (Bridgewater Township, New Jersey), Biotronik (Berlin, Germany), Biosensors (Singapore), Medtronic (Minneapolis, Minnesota), Stentys (Paris, France), Daiichi Sankyo, The Medicines Company, Edwards Lifesciences (Irvine, California), Boston Scientific, and St. Jude Medical (Saint Paul, Minnesota); has received research support from Abbott Vascular , Biotronik , Direct Flow (Santa Rosa, California), St. Jude Medical , Sadra Medical (Los Gatos California), Stentys , and Icon (Dublin, Ireland); and is on the advisory board of Biotronik and Abbott Vascular. Dr. Margey is a proctor for Edwards Lifesciences. Dr. Moses is a consultant for Cordis and Boston Scientific. Dr. Erglis is a consultant for and is on the speakers' bureaus of Medtronic, Boston Scientific, Cordis (Johnson and Johnson), Biosensors, and Abbott Vascular and has received research contracts from Abbott Vascular and Boston Scientific . Dr. Tamburino has received honoraria from CeloNova (San Antonio, Texas), Medtronic , CardioKinetix (Menlo Park, California), and Abbott Vascular . All other authors have reported that they have no relationships relevant to the contents of this report to disclose.
PY - 2014/6/15
Y1 - 2014/6/15
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=84901632672&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84901632672&partnerID=8YFLogxK
U2 - 10.1016/j.amjcard.2014.03.044
DO - 10.1016/j.amjcard.2014.03.044
M3 - Article
C2 - 24793677
AN - SCOPUS:84901632672
SN - 0002-9149
VL - 113
SP - 2007
EP - 2012
JO - American Journal of Cardiology
JF - American Journal of Cardiology
IS - 12
ER -