Long-Term Survival After Surgery Versus Percutaneous Intervention in Octogenarians With Multivessel Coronary Disease

doi:10.1016/j.athoracsur.2007.07.013

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Original Articles: Cardiovascular

Long-Term Survival After Surgery Versus Percutaneous Intervention in Octogenarians With Multivessel Coronary Disease

Lawrence J. Dacey, MD, MS^a^,_*, Donald S. Likosky, PhD^a, Thomas J. Ryan, Jr, MD^b, John F. Robb, MD^a, Reed D. Quinn, MD^b, James T. DeVries, MD^a, Michael J. Hearne, MD^c, Bruce J. Leavitt, MD^d, Robert F. Dunton, MD^e, Robert A. Clough, MD^f, Donato Sisto, MD^g, Cathy S. Ross, MS^a, Elaine M. Olmstead, BA^a, Gerald T. O’Connor, PhD, DSc^a, David J. Malenka, MD^a Northern New England Cardiovascular Disease Study Group

^a Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
^b Maine Medical Center, Portland, Maine
^c Catholic Medical Center, Manchester, New Hampshire
^d Fletcher Allen Health Care, Burlington, Vermont
^e Concord Hospital, Concord, New Hampshire
^f Eastern Maine Medical Center, Bangor, Maine
^g Portsmouth Regional Hospital, Portsmouth, New Hampshire

Accepted for publication July 9, 2007.

^_* Address correspondence to Dr Dacey, Department of Cardiothoracic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, 03756, New Hampshire (Email: lawrence.j.dacey{at}hitchcock.org).

Presented at the Forty-second Annual Meeting of The Society of Thoracic Surgeons, Chicago, IL, Jan 30–Feb 1, 2006.

Background: There is limited information comparing long-term survival afterpercutaneous coronary intervention (PCI) versus coronary arterybypass grafting (CABG) in patients aged 80 years and older.We studied the long-term survival of octogenarians with multivesselcoronary artery disease undergoing PCI or CABG who might havebeen candidates for either procedure.

Methods: We identified 1693 patients, aged 80 to 89, with two-vesseldisease (57.6%) or three-vessel disease (42.4%), without leftmain disease, undergoing a first, nonemergency revascularizationfrom 1992 to 2001. Adjusted hazard ratios (HR) were calculatedfor CABG versus PCI. Because survival curves for these procedurescrossed midway through year 1, results were analyzed separatelyfor the first 6 months and 6 months to 8 years.

Results: PCI was performed in 54.6% of patients with two-vessel diseaseand 23.7% of those with three-vessel disease. More CABG patientswere men (54.7% versus 43.3%). The CABG patients had more peripheralvascular disease (23.1% versus 15.2%) and congestive heart failure(24.5% versus 13.1%) but less renal failure (4.6% versus 9.1%)and fewer prior myocardial infarctions (48.7% versus 53.6%).In-hospital mortality was 3.0% for PCI and 5.9% for CABG (p= 0.005). CABG was associated with poorer survival than PCIduring the first 6 months (HR, 1.32; p = 0.135). Survival from6 months to 8 years was significantly better with CABG for thegroup as a whole (HR, 0.72; p = 0.005) and for patients withtwo-vessel disease (HR, 0.68; p = 0.016), and there was a nonsignificanttrend for those with three-vessel disease (HR, 0.75; p = 0.177).

Conclusions: Patients aged 80 years or older with multivessel disease mustconsider the trade-off between the increased early risks ofCABG in return for improved long-term survival.