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(Circulation. 2008;118:2374-2381.)
© 2008 American Heart Association, Inc.

Interventional Cardiology

Nonrandomized Comparison of Coronary Artery Bypass Surgery and Percutaneous Coronary Intervention for the Treatment of Unprotected Left Main Coronary Artery Disease in Octogenarians

Josep Rodés-Cabau, MD, FESC; Jonathan DeBlois, MD; Olivier F. Bertrand, MD, PhD; Siamak Mohammadi, MD; Javier Courtis, MD; Eric Larose, MD; François Dagenais, MD; Jean-Pierre Déry, MD; Patrick Mathieu, MD; Melanie Rousseau, MS; Gérald Barbeau, MD; Richard Baillot, MD; Onil Gleeton, MD; Jean Perron, MD; Can M. Nguyen, MD; Louis Roy, MD; Daniel Doyle, MD; Robert De Larochellière, MD; Peter Bogaty, MD; Pierre Voisine, MD

From the Departments of Cardiology and Cardiac Surgery, Quebec Heart Institute, Laval Hospital, Quebec, Canada.

Reprint requests to Josep Rodés-Cabau, MD, FESC, Quebec Heart Institute, Laval Hospital, 2725 Chemin Ste-Foy, G1V 4G5 Quebec, Canada. E-mail josep.rodes{at}crhl.ulaval.ca

Received July 19, 2007; accepted September 9, 2008.

Background— The objective of the present study was to compare the midterm follow-up results of percutaneous coronary intervention (PCI) and coronary bypass graft surgery (CABG) for the treatment of unprotected left main coronary artery disease in octogenarians.

Methods and Results— A total of 249 consecutive patients 80 years of age diagnosed with left main coronary artery disease underwent coronary revascularization in our center between January 2002 and January 2008; 145 patients underwent CABG, and 104 patients had PCI. Major adverse cardiac and cerebrovascular events (MACCE [cardiac death, myocardial infarction, cerebrovascular event, revascularization]) were evaluated at a mean follow-up of 23±16 months. Patients who underwent PCI were older; had higher creatinine levels, lower ejection fraction, and higher EuroSCORE; and presented more frequently with an acute coronary syndrome. Drug-eluting stents were used in 48% of PCI patients. A propensity score analysis was performed to adjust for baseline differences between the 2 groups. Survival free of cardiac death or myocardial infarction (PCI, 65.4%; CABG, 69.7%) and MACCE-free survival (PCI, 56.7%; CABG, 64.8%) at follow-up were similar between the groups (adjusted hazard ratio for survival free of cardiac death or myocardial infarction, 1.28; 95% CI, 0.64 to 2.56; P=0.47; adjusted hazard ratio for MACCE-free survival, 1.11; 95% CI, 0.59 to 2.0; P=0.73). The EuroSCORE value was an independent predictor of MACCE regardless of the type of revascularization (hazard ratio, 1.17 for each EuroSCORE increase of 1 point; 95% CI, 1.09 to 1.25; P<0.0001).

Conclusions— In this single-center, nonrandomized study, there were no significant differences in cardiac death or myocardial infarction and MACCE between CABG and PCI for the treatment of left main coronary artery disease in octogenarians after a mean follow-up of 2 years. Baseline EuroSCORE was the most important predictor of MACCE regardless of the type of revascularization. Randomized studies comparing both revascularization strategies in this high-risk coronary population are warranted.

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