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Coronary angioplasty versus bypass surgery in patients > 70 years old matched for ventricular function
J H O'Keefe1, M B Sutton, B D McCallister
1Mid America Heart Institute, St. Luke's Hospital, Kansas City, Missouri.
Insights
For patients over 70, coronary angioplasty and bypass surgery offer similar long-term survival. However, angioplasty shows lower in-hospital risks, while bypass surgery reduces recurrent angina and repeat procedures.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Limited comparative data exist for revascularization strategies in elderly patients.
- Clinical decisions for coronary artery disease treatment in individuals >70 years old require evidence-based guidance.
Purpose of the Study:
- To compare the risks and benefits of coronary angioplasty versus coronary artery bypass graft surgery.
- To evaluate outcomes in patients aged over 70 undergoing these procedures.
Main Methods:
- Retrospective case-control analysis of 195 angioplasty patients and 195 bypass surgery patients.
- Groups were matched for left ventricular function, age, and gender.
- In-hospital and 5-year follow-up outcomes were analyzed.
Main Results:
- Coronary angioplasty demonstrated significantly lower in-hospital morbidity and mortality rates.
- Angioplasty patients had shorter hospital stays (4.8 vs. 14.3 days) and fewer in-hospital strokes and Q wave infarctions.
- Five-year survival rates were comparable (63% angioplasty vs. 65% bypass), but bypass surgery led to less recurrent angina and fewer repeat revascularizations.
Conclusions:
- Coronary angioplasty and bypass surgery yield similar long-term survival in patients over 70.
- Angioplasty offers immediate benefits with lower in-hospital complications.
- Coronary artery bypass graft surgery provides better long-term symptom control and reduces the need for repeat interventions.
Objectives:
This study compared the relative risks and benefits of coronary angioplasty and coronary artery bypass graft surgery in patients > 70 years old.
Background:
Few objective, comparative data exist to guide the clinician in the decision to use bypass surgery or angioplasty in elderly patients.
Methods:
The study was a case-control, retrospective analysis of 195 consecutive patients who underwent bypass surgery in 1987 and 1988 and were compared with a concurrent cohort of 195 coronary angioplasty-treated patients. The groups were matched for left ventricular function, age and gender mix.
Results:
The in-hospital morbidity and mortality rates were significantly lower in the coronary angioplasty-treated patients. Mean postprocedural hospital stay was 4.8 and 14.3 days for angioplasty and surgical group patients, respectively (p < 0.001). In-hospital death occurred in 2% of angioplasty-treated patients compared with 9% of surgically treated patients (p = 0.007). Serious in-hospital stroke occurred in no patient in the angioplasty group and in 5% of patients in the surgical group (p < 0.0001). Q wave infarction occurred in 1% of angioplasty-treated patients and 6% of bypass-treated patients (p = 0.01). The 5-year actuarial survival rate was similar in the two groups: 63% in the angioplasty group, 65% in the bypass group (p = NS). However, surgical group patients experienced less recurrent angina, required fewer repeat revascularization procedures and had fewer Q wave infarctions during follow-up compared with angioplasty group patients.
Conclusions:
When performed in patients > 70 years old, angioplasty and coronary bypass surgery result in similar long-term survival rates but otherwise distinctly different clinical courses.