The Effect of Age on Outcomes of Coronary Artery Bypass Surgery Compared With Balloon Angioplasty or Bare-Metal Stent Implantation Among Patients With Multivessel Coronary Disease

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:60

Article

Flather, Marcus²  Rhee, June-Wha¹  Boothroyd, Derek B.¹  Boersma, Eric³  Brooks, Maria Mori⁴  Carrie, Didier⁵  Clayton, Tim C.⁶  Danchin, Nicholas⁷  Hamm, Christian W.⁸  Hueb, Whady A.⁹  King, Spencer B.¹⁰  Pocock, Stuart J.⁶  Rodriguez, Alfredo E.¹¹  Serruys, Patrick³  Sigwart, Ulrich¹²  Stables, Rodney H.¹³  Hlatky, Mark A.¹ 

[1] Stanford Univ, Sch Med, Stanford, CA 94305 USA

[2] Univ E Anglia, Norwich NR4 7TJ, Norfolk, England

[3] Erasmus MC, Rotterdam, Netherlands

[4] Univ Pittsburgh, Grad Sch Publ Hlth, Pittsburgh, PA USA

[5] Hop Rangueil, Toulouse, France

[6] London Sch Hyg & Trop Med, London WC1, England

[7] Univ Paris 05, Paris, France

[8] Kerckhoff Heart & Thorax Ctr, Bad Nauheim, Germany

[9] Inst Coracao, Sao Paulo, Brazil

[10] St Josephs Heart & Vasc Inst, Atlanta, GA USA

[11] Sanatario Otamendi, Buenos Aires, DF, Argentina

[12] Univ Geneva, Geneva, Switzerland

[13] Liverpool Heart & Chest Hosp, Liverpool, Merseyside, England

关键词: comparative effectiveness;    coronary bypass surgery;    percutaneous coronary intervention;   

DOI  :  10.1016/j.jacc.2012.08.982

来源: Elsevier

【 摘 要 】

Objectives This study sought to assess whether patient age modifies the comparative effectiveness of coronary artery bypass graft (CABG) surgery and percutaneous coronary intervention (PCI). Background Increasingly, CABG and PCI are performed in older patients to treat multivessel disease, but their comparative effectiveness is uncertain. Methods Individual data from 7,812 patients randomized in 1 of 10 clinical trials of CABG or PCI were pooled. Age was analyzed as a continuous variable in the primary analysis and was divided into tertiles for descriptive purposes (<= 56.2 years, 56.3 to 65.1 years, >= 65.2 years). The outcomes assessed were death, myocardial infarction and repeat revascularization over complete follow-up, and angina at 1 year. Results Older patients were more likely to have hypertension, diabetes, and 3-vessel disease compared with younger patients (p < 0.001 for trend). Over a median follow-up of 5.9 years, the effect of CABG versus PCI on mortality varied according to age (interaction p < 0.01), with adjusted CABG-to-PCI hazard ratios and 95% confidence intervals (CI) of 1.23 (95% CI: 0.95 to 1.59) in the youngest tertile; 0.89 (95% CI: 0.73 to 1.10) in the middle tertile; and 0.79 (95% CI: 0.67 to 0.94) in the oldest tertile. The CABG-to-PCI hazard ratio of less than 1 for patients 59 years of age and older. A similar interaction of age with treatment was present for the composite outcome of death or myocardial infarction. In contrast, patient age did not alter the comparative effectiveness of CABG and PCI on the outcomes of repeat revascularization or angina. Conclusions Patient age modifies the comparative effectiveness of CABG and PCI on hard cardiac events, with CABG favored at older ages and PCI favored at younger ages. (J Am Coll Cardiol 2012;60:2150-7) (C) 2012 by the American College of Cardiology Foundation

【 授权许可】

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