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Survival after coronary revascularization in the elderly
Michelle M Graham1, William A Ghali, Peter D Faris
1Department of Medicine, University of Alberta, Canada.
Insights
Elderly patients with ischemic heart disease benefit more from revascularization therapies like coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) than previously thought. These aggressive treatments show greater absolute risk reductions in older adults compared to medical therapy alone.
Area of Science:
- Cardiology
- Geriatric Medicine
- Clinical Outcomes Research
Background:
- Elderly patients with ischemic heart disease (IHD) are increasingly candidates for revascularization.
- Concerns exist regarding suboptimal outcomes in older adults undergoing coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI).
- This study investigates survival rates across different treatment strategies in distinct elderly age groups.
Purpose of the Study:
- To compare the survival outcomes of elderly patients with ischemic heart disease based on their prescribed treatment.
- To analyze survival rates for coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), and medical therapy across age strata.
- To determine if revascularization offers greater benefits in older patient populations.
Main Methods:
- Utilized data from the Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease (APPROACH) initiative.
- Compared characteristics and long-term outcomes of over 6000 elderly patients with IHD to younger cohorts.
- Analyzed 4-year adjusted actuarial survival rates for CABG, PCI, and medical therapy in patients aged <70, 70-79, and ≥80 years.
Main Results:
- In patients ≥80 years, 4-year survival was 77.4% for CABG, 71.6% for PCI, and 60.3% for medical therapy.
- Patients ≥80 years showed greater absolute risk reductions with CABG (17.0%) and PCI (11.3%) compared to medical therapy than younger patients.
- Survival rates for all treatments generally decreased with increasing age, but the benefit of revascularization over medical therapy was more pronounced in the oldest group.
Conclusions:
- Elderly patients, particularly those ≥80 years, experience paradoxically greater absolute risk reductions from revascularization (CABG/PCI) compared to younger individuals.
- Findings suggest that aggressive revascularization strategies may be highly beneficial for specific subsets of older patients with ischemic heart disease.
- These results, combined with prior trials, support considering revascularization for older patient populations.
Background:
Elderly patients with ischemic heart disease are increasingly referred for coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). However, reports of poor outcomes in the elderly have led to questions about the benefit of these strategies. We studied survival by prescribed treatment (CABG, PCI, or medical therapy) for patients in 3 age categories: <70 years, 70 to 79 years, and > or =80 years of age.
Methods And Results:
The Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease (APPROACH) is a clinical data collection and outcome monitoring initiative capturing all patients undergoing cardiac catheterization and revascularization in the province of Alberta, Canada, since 1995. Characteristics and long-term outcomes of a cohort of >6000 elderly patients with ischemic heart disease were compared with younger patients. In 15 392 patients >70 years of age, 4-year adjusted actuarial survival rates for CABG, PCI, and medical therapy were 95.0%, 93.8%, and 90.5%, respectively. In 5198 patients 70 to 79 years of age, survival rates were 87.3%, 83.9%, and 79.1%, respectively. In 983 patients > or = 80 years of age, survival was 77.4% for CABG, 71.6% for PCI, and 60.3% for medical therapy. Absolute risk differences in comparison to medical therapy for CABG (17.0%) and PCI (11.3%) were greater for patients > or =80 years of age than for younger patients.
Conclusions:
Elderly patients paradoxically have greater absolute risk reductions associated with surgical or percutaneous revascularization than do younger patients. The combination of these results with a recent randomized trial suggests that the benefits of aggressive revascularization therapies may extend to subsets of patients in older age groups.
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