TY - JOUR AU - Ben-Gal, Yanai AU - Finkelstein, Ariel AU - Banai, Shmuel AU - Medalion, Benjamin AU - Weisz, Giora AU - Genereux, Philippe AU - Moshe, Shelly AU - Pevni, Dmitry AU - Aviram, Galit AU - Uretzky, Gideon PY - 2012/08/23 Y2 - 2024/03/29 TI - Surgical Myocardial Revascularization versus Percutaneous Coronary Intervention with Drug-Eluting Stents in Octogenarian Patients JF - The Heart Surgery Forum JA - HSF VL - 15 IS - 4 SE - DO - 10.1532/HSF98.20111190 UR - https://journal.hsforum.com/index.php/HSF/article/view/76 SP - E204-E209 AB - <p><b>Objective:</b> Our goal was to compare the clinical outcomes of octogenarian (or older) patients who are referred for either surgical or percutaneous coronary revascularization.</p><p><b>Methods:</b> We retrospectively evaluated the outcomes of all patients 80 years of age who had undergone coronary artery bypass grafting (CABG) with an internal mammary artery or had undergone a percutaneous coronary intervention (PCI) with a sirolimus-eluting stent to the left anterior descending artery in our center between May 2002 and December 2006.</p><p><b>Results:</b> Of the 301 patients, 120 underwent a PCI, and 181 underwent CABG. Surgical patients had higher rates of left main disease, triple-vessel disease, peripheral vascular disease, emergent procedures, and previous myocardial infarctions (39.7% versus 3.3% [<i>P</i> = .001], 76.1% versus 28.3% [<i>P</i> = .0001], 19.6% versus 7.5% [<i>P</i> = .004], 15.8% versus 2.5% [<i>P</i> = .0001], and 35.9% versus 25% [<i>P</i> = .04], respectively). CABG patients had a higher early mortality rate (9.9% versus 2.5%, <i>P</i> = .01). There were no differences in 1- and 4-year actuarial survival rates, with rates of 90% and 68%, respectively, for the PCI group and 85% and 71% for the CABG group (<i>P</i> = .85). The rates of actuarial freedom from major adverse cardiac events (MACEs) at 1 and 4 years were 83% and 75%, respectively, for the PCI group, and 86% and 78% for the CABG group (<i>P</i> = .33). The respective rates of freedom from reintervention were 87% and 83% for the PCI group, versus 99% and 97% for the CABG group (<i>P</i> < .001). The 4-year rate of freedom from recurring angina was 58% for the PCI group, versus 88% for CABG patients (<i>P</i> < .001). Revascularization strategy was not a predictor of adverse outcome in a multivariable analysis.</p><p><b>Conclusion:</b> Octogenarian CABG patients were sicker and experienced a higher rate of early mortality. The 2 strategies had similar rates of late mortality and MACEs, with fewer reinterventions and recurring angina occurring following surgery.</p> ER -