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Three-year outcomes of multivessel revascularization in very elderly acute coronary syndrome patients

Brett C Sheridan1, Sally C Stearns, Joseph S Rossi

  • 1Division of Cardiothoracic Surgery, Department of Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7065, USA. sheridan@med.unc.edu

The Annals of Thoracic Surgery
|May 25, 2010
PubMed

Insights

For very elderly patients with acute coronary syndrome, coronary artery bypass grafting (CABG) shows better long-term survival and fewer adverse events than percutaneous coronary intervention (PCI). CABG offers an advantage over PCI at three years for this population.

Area of Science:

  • Cardiology
  • Geriatric Medicine
  • Interventional Cardiology

Background:

  • Comparative effectiveness of acute coronary syndrome (ACS) interventions in the very elderly is unclear.
  • Interventional treatments include percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG).
  • Elderly patients are often directed to PCI due to perceived equipoise and increased CABG risk.

Purpose of the Study:

  • To evaluate long-term outcomes of CABG versus PCI in very elderly Medicare beneficiaries with ACS.
  • To compare survival and composite endpoints between the two treatment strategies.

Main Methods:

  • Analysis of Medicare claims data for 10,141 beneficiaries aged 85+ diagnosed with ACS in 2003-2004.
  • Follow-up for three years assessing survival and composite outcomes (death, repeat revascularization, stroke, myocardial infarction).
  • Logistic regressions and propensity score adjustment controlled for demographics and comorbidities.

Main Results:

  • PCI demonstrated early benefits in reduced morbidity and mortality.
  • By three years, CABG outcomes improved significantly compared to PCI (p < 0.01).
  • At 36 months, CABG recipients had higher survival (66.0% vs. 62.7%, p < 0.05) and freedom from composite outcomes (46.1% vs. 38.7%, p < 0.01).

Conclusions:

  • CABG offers a survival and composite endpoint advantage over PCI in very elderly patients with ACS and multivessel coronary artery disease at three years.
  • Optimal CABG benefit in this population requires absence of significant congestive heart failure, lung disease, and peripheral vascular disease.
Abstract

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