Abstract 1813: Long-term Outcome of Older Patients with Stable Multivessel Disease Treated Medically versus with Revascularization: Results from the Medical, Angioplasty or Surgery Study (MASS II)
Background: As the population becomes proportionally older and the cardiovascular disease is the leading cause of death in subjects older than 65 years, assessment of option therapeutics in older age groups is essential. We studied whether older age influences outcomes in patients with chronic coronary artery disease (CAD) and left ventricular function preserved.
Methods: From the MASS II Study (Medical, Angioplasty or Surgery Study II), a randomized trial comparing treatments for individuals with CAD and preserved left ventricle function, 611 patients were studied and prospectively followed for 3 years. Differences in clinical presentation and 3 years outcomes were compared between patient age groups: younger ( < 65 years, n = 392) and older (65 to 79 years, n = 219). Composite end-points of cardiac death, myocardial infarction and refractory angina requiring revascularization were analyzed in each age group.
Results: Compared to younger patients, older patients were more female (36.55 versus 27.6%, p= 0.021), with more 3 vessels diseases (64.8% versus 55.1%, p = 0.19) and less smokers 22.4% versus 36.8%, p < 0.001). At 3 years follow-up, when analyzed primary end-points, older group presented more cardiac death (11% versus 4.1%, p < 0.001), myocardial infarction (11.4% versus 6.4%, p = 0.020) and needing of additional intervention (12.3% versus 7.1%, p = 0.032) ratio for cardiac death (p < 0.005, HR 2.5, 95%CI 1.32– 4.74) and for composite end-points (p = 0.002, HR 1.748, 95% CI 1.238–2.469) were both significantly increase by age in a Cox proportional hazards survival model. Although, there were no significant differences between groups regard the randomized therapeutic option, in the older group, there was a trend towards of better outcome in CABG treatment (p = 0.057). However, compared to younger patients, there were a significant worse outcomes for the patients undergoing to CABG (p = 0.016) or medical treatment (p = 0.013).
Conclusion: Our data indicates a strong and consistent relationship of older age and long-term relative risk of worse outcomes in patients with stable coronary disease and preserved left ventricular function. Also, a potential benefit for CABG on the older patients was suggested as an option therapeutic.