Abstract 13691: Long-Term Outcomes of Elderly Patients Who Underwent Surgery, Angioplasty or Medical Treatment - 10 Year Follow-Up. Mass II Trial
Purpose: As population becomes proportionally older, Coronary Artery Disease (CAD) is diagnosed in more advanced ages. There are few studies comparing the treatment options for CAD in elderly patients. This current investigation compares the treatment options for CAD in patients ≥ 65 years.
Methods: This study is a post-hoc analysis of the Medical, Angioplasty or Surgery Study (MASS II), a randomized trial comparing medical treatment (MT), percutaneous coronary intervention (PCI) and coronary artery bypass surgery (CABG) in 611 multivessel CAD patients with preserved left ventricular function. Patients were separated according to age: ≥ 65 years (n=200) and < 65 years (n=411). All patients were followed for ten years. We analyze the rates of overall mortality and the occurrence of acute myocardial infarction (MI), new revascularizations and combined major events comparing the three strategies in these two age groups.
Results: Patients ≥ 65 years (n=200) were randomized for MT (n=68), PCI (n=68) or CABG (n=64) treatment. The overall survival rates in each strategy were 63% MT, 69% PCI and 66% CABG, p=0.93. The survival rates free of combined events were 43% MT, 38% PCI and 66% CABG, p =0.007. The survival rates free of MI were 82% MT, 77% PCI and 90% CABG, p = 0.17 and the survival rates free of reinterventions were 59% MT, 58% PCI and 91% CABG, p=0.0003. When we compare the groups (age ≥ 65 years versus age< 65years) the survival rates free of MI for PCI treated patients were 77% and 91.7% respectively (p=0.0046).
Conclusion There was no prognostic difference between the three options for the treatment of CAD in elderly patients in terms of overall mortality. However, CABG was associated with fewer incidences of combined events and reinterventions. When compared to younger patients, the older group who underwent PCI had a higher incidence of MI.
- © 2011 by American Heart Association, Inc.