Circulation. 2002;105:2378-2384
Published online before print May 6, 2002, doi: 10.1161/01.CIR.0000016640.99114.3D
Published online before print May 6, 2002, doi: 10.1161/01.CIR.0000016640.99114.3D
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(Circulation. 2002;105:2378.)
© 2002 American Heart Association, Inc.
Clinical Investigation and Reports |
Survival After Coronary Revascularization in the Elderly
From the Departments of Medicine (M.M.G.) and Public Health Sciences (C.M.N.), University of Alberta; the Departments of Medicine (W.A.G., M.L.K.) and Community Health Sciences (W.A.G.), University of Calgary; and the APPROACH Project Offices (P.D.F., P.D.G.), Calgary and Edmonton, Canada.
Correspondence to Dr W.A. Ghali, Faculty of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, Alberta, Canada, T2N 4N1. E-mail wghali{at}ucalgary.ca
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 
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 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 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.
Key Words: aging • survival • revascularization • coronary disease
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