This Article Free upon publication Full Text Full Text (PDF) All Versions of this Article: 118/23/2374    most recent CIRCULATIONAHA.107.727099v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Rodés-Cabau, J. Articles by Voisine, P. Search for Related Content PubMed PubMed Citation Articles by Rodés-Cabau, J. Articles by Voisine, P. Related Collections Catheter-based coronary interventions: stents CV surgery: coronary artery disease Related Article

(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.

---

 

CLINICAL PERSPECTIVE

Related Article:

Circulation: Clinical Summaries
Circulation 2008 118: 2319-2320. [Extract] [Full Text]

This article has been cited by other articles:

				F. G. Kushner, M. Hand, S. C. Smith Jr, S. B. King III, J. L. Anderson, E. M. Antman, S. R. Bailey, E. R. Bates, J. C. Blankenship, D. E. Casey Jr, et al. 2009 Focused Updates: ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction (Updating the 2004 Guideline and 2007 Focused Update) and ACC/AHA/SCAI Guidelines on Percutaneous Coronary Intervention (Updating the 2005 Guideline and 2007 Focused Update): A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines J. Am. Coll. Cardiol., December 1, 2009; 54(23): 2205 - 2241. [Full Text] [PDF]

				A. Cassar, D. R. Holmes Jr, C. S. Rihal, and B. J. Gersh Chronic Coronary Artery Disease: Diagnosis and Management Mayo Clin. Proc., December 1, 2009; 84(12): 1130 - 1146. [Abstract] [Full Text] [PDF]

				F. G. Kushner, M. Hand, S. C. Smith Jr, S. B. King III, J. L. Anderson, E. M. Antman, S. R. Bailey, E. R. Bates, J. C. Blankenship, D. E. Casey Jr, et al. 2009 Focused Updates: ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction (Updating the 2004 Guideline and 2007 Focused Update) and ACC/AHA/SCAI Guidelines on Percutaneous Coronary Intervention (Updating the 2005 Guideline and 2007 Focused Update): A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Circulation, December 1, 2009; 120(22): 2271 - 2306. [Full Text] [PDF]

				D. E. Kandzari, A. Colombo, S.-J. Park, C. L. Tommaso, S. G. Ellis, L. A. Guzman, P. S. Teirstein, C. Tamburino, J. Ormiston, G. W. Stone, et al. Revascularization for unprotected left main disease: evolution of the evidence basis to redefine treatment standards. J. Am. Coll. Cardiol., October 20, 2009; 54(17): 1576 - 1588. [Abstract] [Full Text] [PDF]

				G. Montalescot, D. Brieger, K. A. Eagle, F. A. Anderson Jr, G. FitzGerald, M. S. Lee, Ph. G. Steg, A. Avezum, S. G. Goodman, J. M. Gore, et al. Unprotected left main revascularization in patients with acute coronary syndromes Eur. Heart J., October 1, 2009; 30(19): 2308 - 2317. [Abstract] [Full Text] [PDF]

				H. Naik, A. J. White, T. Chakravarty, J. Forrester, G. Fontana, S. Kar, P. K. Shah, R. E. Weiss, and R. Makkar A Meta-Analysis of 3,773 Patients Treated With Percutaneous Coronary Intervention or Surgery for Unprotected Left Main Coronary Artery Stenosis J. Am. Coll. Cardiol. Intv., August 1, 2009; 2(8): 739 - 747. [Abstract] [Full Text] [PDF]

				S. R. Dixon, C. L. Grines, and W. W. O'Neill The year in interventional cardiology. J. Am. Coll. Cardiol., June 2, 2009; 53(22): 2080 - 2097. [Full Text] [PDF]

				F. Alfonso Left main coronary artery stenting crossing the rubicon. J. Am. Coll. Cardiol., May 12, 2009; 53(19): 1769 - 1772. [Full Text] [PDF]

				C. Wu, E. L. Hannan, G. Walford, and D. P. Faxon Reply. Ann. Thorac. Surg., May 1, 2009; 87(5): 1652 - 1653. [Full Text] [PDF]

				Revascularization of Unprotected Left Main Lesions in Octogenarians Journal Watch Cardiology, January 14, 2009; 2009(114): 2 - 2. [Full Text]

				R. J. Shemin Coronary Artery Bypass Grafting Versus Stenting for Unprotected Left Main Coronary Artery Disease: Where Lies the Body of Proof? Circulation, December 2, 2008; 118(23): 2326 - 2329. [Full Text] [PDF]