Document Detail


Three-year outcomes of multivessel revascularization in very elderly acute coronary syndrome patients.
MedLine Citation:
PMID:  20494044     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Comparative effectiveness of interventional treatment strategies for the very elderly with acute coronary syndrome remains poorly defined due to study exclusions. Interventions include percutaneous coronary intervention (PCI), usually with stents, or coronary artery bypass grafting (CABG). The elderly are frequently directed to PCI because of provider perceptions that PCI is at therapeutic equipoise with CABG and that CABG incurs increased risk. We evaluated long-term outcomes of CABG versus PCI in a cohort of very elderly Medicare beneficiaries presenting with acute coronary syndrome.
METHODS: Using Medicare claims data, we analyzed outcomes of multivessel PCI or CABG treatment for a cohort of 10,141 beneficiaries age 85 and older diagnosed with acute coronary syndrome in 2003 and 2004. The cohort was followed for survival and composite outcomes (death, repeat revascularization, stroke, acute myocardial infarction) for three years. Logistic regressions controlled for patient demographics and comorbidities with propensity score adjustment for procedure selection.
RESULTS: Percutaneous coronary intervention showed early benefits of lesser morbidity and mortality, but CABG outcomes improved relative to PCI outcomes by three years (p < 0.01). At 36 months post-initial revascularization, 66.0% of CABG recipients survived (versus 62.7% of PCI recipients, p < 0.05) and 46.1% of CABG recipients were free from composite outcome (versus 38.7% of PCI recipients, p < 0.01).
CONCLUSIONS: In very elderly patients with ACS and multivessel CAD, CABG appears to offer an advantage over PCI of survival and freedom from composite endpoint at three years. Optimizing the benefit of CABG in very elderly patients requires absence of significant congestive heart failure, lung disease, and peripheral vascular disease.
Authors:
Brett C Sheridan; Sally C Stearns; Joseph S Rossi; Laura P D'Arcy; Jerome J Federspiel; Timothy S Carey
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  89     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2010-05-24     Completed Date:  2010-06-16     Revised Date:  2014-11-13    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  1889-94; discussion 1894-5     Citation Subset:  AIM; IM    
Copyright Information:
2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
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MeSH Terms
Descriptor/Qualifier:
Acute Coronary Syndrome / surgery*
Age Factors
Aged, 80 and over
Angioplasty, Balloon, Coronary*
Coronary Artery Bypass*
Female
Follow-Up Studies
Humans
Male
Retrospective Studies
Time Factors
Treatment Outcome
Grant Support
ID/Acronym/Agency:
1R01AG025801/AG/NIA NIH HHS; 2T32GM008719/GM/NIGMS NIH HHS; R01 AG025801/AG/NIA NIH HHS; R01 AG025801-01A1/AG/NIA NIH HHS; R01 AG025801-02/AG/NIA NIH HHS; R01 AG025801-03/AG/NIA NIH HHS; R01 AG025801-03S1/AG/NIA NIH HHS; T32 GM008719/GM/NIGMS NIH HHS; T32 GM008719-07/GM/NIGMS NIH HHS; T32 GM008719-08/GM/NIGMS NIH HHS; T32 GM008719-09/GM/NIGMS NIH HHS; T32 GM008719-10/GM/NIGMS NIH HHS; T32 GM008719-11/GM/NIGMS NIH HHS; T32 GM008719-12/GM/NIGMS NIH HHS
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