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Ann Thorac Surg 1994;58:1419-1426
© 1994 The Society of Thoracic Surgeons

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Articles

Angioplasty versus coronary artery bypass in octogenarians

Department of Cardiac Surgery, Princeton-Baptist Medical Center, Birmingham, Alabama USA

Accepted for publication April 11, 1994.

^_* Address reprint requests to Dr Kaul, Department of Cardiac Surgery, Princeton-Baptist Medical Center, 817 Princeton Ave, SW Suite 300, Birmingham, AL 35211.

We retrospectively analyzed early and late results for two treatment strategies of significant coronary artery disease in 310 octogenarians seen in the last 10 years. One hundred five patients 80 or more years of age had percutaneous transluminal coronary angioplasty (PTCA) and 205 had coronary artery bypass grafting (CABG). The PTCA group differed from the CABG group in having a greater proportion of women (71.4% versus 45.8%; p < 0.001); fewer patients with unstable angina (24.7% versus 33.6%; p < 0.04), acute myocardial infarction (11% versus 23%; p < 0.04), three-vessel coronary artery disease (20% versus 56%; p < 0.0001), and a left ventricular ejection fraction less than or equal to 0.30 (10% versus 21%; p < 0.008); and fewer vessels revascularized (1.2 ± 0.6 versus 3.5 ± 0.9; p < 0.0001). Hospital mortality was 8.57% after PTCA ( [equation] failed PTCA) and 5.8% after CABG ( [equation] emergent, [equation] urgent, and [equation] elective). Hospital stay was 7 ± 0.9 days after PTCA and 14 ± 1.5 days after CABG (p < 0.01). Independent predictors of hospital mortality obtained by multivariate analysis included failed PTCA and acute myocardial infarction (PTCA group), a left ventricular ejection fraction equal to or less than 0.30, and acute myocardial infarction and emergency CABG (CABG group). Survivors after both CABG and PTCA showed a significant improvement in their New York Heart Association class. Actuarial survival at 5 years after PTCA was 55% and after CABG it was 66% (p < 0.01). Cardiac event-free survival (deaths, myocardial infarction, PTCA, CABG) at 3 years was 61% after PTCA and 81% after CABG (p < 0.01). In octogenarians, PTCA had a greater mortality and failure rate than in our younger patients. Overall morbidity was higher after CABG than after PTCA (p < 0.05), given the nature and the severity of the increased risk factors in the CABG group.

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