Surgical myocardial revascularization versus percutaneous coronary intervention with drug-eluting stents in octogenarian patients

Yanai Ben-Gal, Ariel Finkelstein, Shmuel Banai, Benjamin Medalion, Giora Weisz, Philippe Genereux, Shelly Moshe, Dmitry Pevni, Galit Aviram, Gideon Uretzky

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Objective: Our goal was to compare the clinical outcomes of octogenarian (or older) patients who are referred for either surgical or percutaneous coronary revascularization. Methods: We retrospectively evaluated the outcomes of all patients 80 years of age who had undergone coronary artery bypass grafting (CABG) with an internal mammary artery or had undergone a percutaneous coronary intervention (PCI) with a sirolimus-eluting stent to the left anterior descending artery in our center between May 2002 and December 2006. Results: Of the 301 patients, 120 underwent a PCI, and 181 underwent CABG. Surgical patients had higher rates of left main disease, triple-vessel disease, peripheral vascular disease, emergent procedures, and previous myocardial infarctions (39.7% versus 3.3% [P = .001], 76.1% versus 28.3% [P = .0001], 19.6% versus 7.5% [P = .004], 15.8% versus 2.5% [P = .0001], and 35.9% versus 25% [P = .04], respectively). CABG patients had a higher early mortality rate (9.9% versus 2.5%, P = .01). There were no differences in 1- and 4-year actuarial survival rates, with rates of 90% and 68%, respectively, for the PCI group and 85% and 71% for the CABG group (P = .85). The rates of actuarial freedom from major adverse cardiac events (MACEs) at 1 and 4 years were 83% and 75%, respectively, for the PCI group, and 86% and 78% for the CABG group (P = .33). The respective rates of freedom from reintervention were 87% and 83% for the PCI group, versus 99% and 97% for the CABG group (P < .001). The 4-year rate of freedom from recurring angina was 58% for the PCI group, versus 88% for CABG patients (P < .001). Revascularization strategy was not a predictor of adverse outcome in a multivariable analysis. Conclusion: Octogenarian CABG patients were sicker and experienced a higher rate of early mortality. The 2 strategies had similar rates of late mortality and MACEs, with fewer reinterventions and recurring angina occurring following surgery.

Original languageEnglish (US)
JournalHeart Surgery Forum
Volume15
Issue number4
DOIs
StatePublished - Aug 1 2012
Externally publishedYes

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Myocardial Revascularization
Drug-Eluting Stents
Percutaneous Coronary Intervention
Coronary Artery Bypass
Mortality
Mammary Arteries
Peripheral Vascular Diseases
Sirolimus
Stents
Survival Rate
Arteries
Myocardial Infarction

All Science Journal Classification (ASJC) codes

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

Ben-Gal, Yanai ; Finkelstein, Ariel ; Banai, Shmuel ; Medalion, Benjamin ; Weisz, Giora ; Genereux, Philippe ; Moshe, Shelly ; Pevni, Dmitry ; Aviram, Galit ; Uretzky, Gideon. / Surgical myocardial revascularization versus percutaneous coronary intervention with drug-eluting stents in octogenarian patients. In: Heart Surgery Forum. 2012 ; Vol. 15, No. 4.
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title = "Surgical myocardial revascularization versus percutaneous coronary intervention with drug-eluting stents in octogenarian patients",
abstract = "Objective: Our goal was to compare the clinical outcomes of octogenarian (or older) patients who are referred for either surgical or percutaneous coronary revascularization. Methods: We retrospectively evaluated the outcomes of all patients 80 years of age who had undergone coronary artery bypass grafting (CABG) with an internal mammary artery or had undergone a percutaneous coronary intervention (PCI) with a sirolimus-eluting stent to the left anterior descending artery in our center between May 2002 and December 2006. Results: Of the 301 patients, 120 underwent a PCI, and 181 underwent CABG. Surgical patients had higher rates of left main disease, triple-vessel disease, peripheral vascular disease, emergent procedures, and previous myocardial infarctions (39.7{\%} versus 3.3{\%} [P = .001], 76.1{\%} versus 28.3{\%} [P = .0001], 19.6{\%} versus 7.5{\%} [P = .004], 15.8{\%} versus 2.5{\%} [P = .0001], and 35.9{\%} versus 25{\%} [P = .04], respectively). CABG patients had a higher early mortality rate (9.9{\%} versus 2.5{\%}, P = .01). There were no differences in 1- and 4-year actuarial survival rates, with rates of 90{\%} and 68{\%}, respectively, for the PCI group and 85{\%} and 71{\%} for the CABG group (P = .85). The rates of actuarial freedom from major adverse cardiac events (MACEs) at 1 and 4 years were 83{\%} and 75{\%}, respectively, for the PCI group, and 86{\%} and 78{\%} for the CABG group (P = .33). The respective rates of freedom from reintervention were 87{\%} and 83{\%} for the PCI group, versus 99{\%} and 97{\%} for the CABG group (P < .001). The 4-year rate of freedom from recurring angina was 58{\%} for the PCI group, versus 88{\%} for CABG patients (P < .001). Revascularization strategy was not a predictor of adverse outcome in a multivariable analysis. Conclusion: Octogenarian CABG patients were sicker and experienced a higher rate of early mortality. The 2 strategies had similar rates of late mortality and MACEs, with fewer reinterventions and recurring angina occurring following surgery.",
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Surgical myocardial revascularization versus percutaneous coronary intervention with drug-eluting stents in octogenarian patients. / Ben-Gal, Yanai; Finkelstein, Ariel; Banai, Shmuel; Medalion, Benjamin; Weisz, Giora; Genereux, Philippe; Moshe, Shelly; Pevni, Dmitry; Aviram, Galit; Uretzky, Gideon.

In: Heart Surgery Forum, Vol. 15, No. 4, 01.08.2012.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Surgical myocardial revascularization versus percutaneous coronary intervention with drug-eluting stents in octogenarian patients

AU - Ben-Gal, Yanai

AU - Finkelstein, Ariel

AU - Banai, Shmuel

AU - Medalion, Benjamin

AU - Weisz, Giora

AU - Genereux, Philippe

AU - Moshe, Shelly

AU - Pevni, Dmitry

AU - Aviram, Galit

AU - Uretzky, Gideon

PY - 2012/8/1

Y1 - 2012/8/1

N2 - Objective: Our goal was to compare the clinical outcomes of octogenarian (or older) patients who are referred for either surgical or percutaneous coronary revascularization. Methods: We retrospectively evaluated the outcomes of all patients 80 years of age who had undergone coronary artery bypass grafting (CABG) with an internal mammary artery or had undergone a percutaneous coronary intervention (PCI) with a sirolimus-eluting stent to the left anterior descending artery in our center between May 2002 and December 2006. Results: Of the 301 patients, 120 underwent a PCI, and 181 underwent CABG. Surgical patients had higher rates of left main disease, triple-vessel disease, peripheral vascular disease, emergent procedures, and previous myocardial infarctions (39.7% versus 3.3% [P = .001], 76.1% versus 28.3% [P = .0001], 19.6% versus 7.5% [P = .004], 15.8% versus 2.5% [P = .0001], and 35.9% versus 25% [P = .04], respectively). CABG patients had a higher early mortality rate (9.9% versus 2.5%, P = .01). There were no differences in 1- and 4-year actuarial survival rates, with rates of 90% and 68%, respectively, for the PCI group and 85% and 71% for the CABG group (P = .85). The rates of actuarial freedom from major adverse cardiac events (MACEs) at 1 and 4 years were 83% and 75%, respectively, for the PCI group, and 86% and 78% for the CABG group (P = .33). The respective rates of freedom from reintervention were 87% and 83% for the PCI group, versus 99% and 97% for the CABG group (P < .001). The 4-year rate of freedom from recurring angina was 58% for the PCI group, versus 88% for CABG patients (P < .001). Revascularization strategy was not a predictor of adverse outcome in a multivariable analysis. Conclusion: Octogenarian CABG patients were sicker and experienced a higher rate of early mortality. The 2 strategies had similar rates of late mortality and MACEs, with fewer reinterventions and recurring angina occurring following surgery.

AB - Objective: Our goal was to compare the clinical outcomes of octogenarian (or older) patients who are referred for either surgical or percutaneous coronary revascularization. Methods: We retrospectively evaluated the outcomes of all patients 80 years of age who had undergone coronary artery bypass grafting (CABG) with an internal mammary artery or had undergone a percutaneous coronary intervention (PCI) with a sirolimus-eluting stent to the left anterior descending artery in our center between May 2002 and December 2006. Results: Of the 301 patients, 120 underwent a PCI, and 181 underwent CABG. Surgical patients had higher rates of left main disease, triple-vessel disease, peripheral vascular disease, emergent procedures, and previous myocardial infarctions (39.7% versus 3.3% [P = .001], 76.1% versus 28.3% [P = .0001], 19.6% versus 7.5% [P = .004], 15.8% versus 2.5% [P = .0001], and 35.9% versus 25% [P = .04], respectively). CABG patients had a higher early mortality rate (9.9% versus 2.5%, P = .01). There were no differences in 1- and 4-year actuarial survival rates, with rates of 90% and 68%, respectively, for the PCI group and 85% and 71% for the CABG group (P = .85). The rates of actuarial freedom from major adverse cardiac events (MACEs) at 1 and 4 years were 83% and 75%, respectively, for the PCI group, and 86% and 78% for the CABG group (P = .33). The respective rates of freedom from reintervention were 87% and 83% for the PCI group, versus 99% and 97% for the CABG group (P < .001). The 4-year rate of freedom from recurring angina was 58% for the PCI group, versus 88% for CABG patients (P < .001). Revascularization strategy was not a predictor of adverse outcome in a multivariable analysis. Conclusion: Octogenarian CABG patients were sicker and experienced a higher rate of early mortality. The 2 strategies had similar rates of late mortality and MACEs, with fewer reinterventions and recurring angina occurring following surgery.

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