Abstract 2475: Comparative Survival of General Medicare Patients after Surgical versus Percutaneous Coronary Intervention in the Era of Drug-Eluting Stents and Impact of Chronic Kidney Disease
Few data exist on the survival of elderly patients undergoing coronary revascularization in the era of drug eluting stents (DES). We searched the claims records of 2,158,970 pts in the 5% General Medicare database to find pts having CAB (without valvular surgery) or PCI with DES or non-DES (not drug eluting stent) in 2003. Long-term survival was estimated by Kaplan-Meier method and independent predictors of death were examined in a comorbidity-adjusted Cox model.
RESULTS: There were 5299 CAB pts, 7989 non-DES pts, and 3739 DES pts. The cohort was 59.5% male, 91.8% white, 53.4% age 65–74, 41.0% age 75– 84, and 5.7% age 85±. 1904 pts (11.2%) had chronic kidney disease (CKD) and 34% had diabetes. The Table⇓ shows survival and predictors of death (age 65–74, male, white, no comorbidity, CAB is reference) with risk ratio (RR). In CKD pts the RR for death was 0.78 (0.63, 0.97) for non-DES and 0.66 (0.48, 0.90) for DES vs. CAB.
Conclusion: Increased mortality occurs in elderly CKD undergoing coronary revascularization. Our data suggest that the one year survival of General Medicare patients is better with drug-eluting stents compared to coronary artery bypass surgery.