Author/Authors :
Conrotto، نويسنده , , Federico and Scacciatella، نويسنده , , Paolo and DʹAscenzo، نويسنده , , Fabrizio and Chieffo، نويسنده , , Alaide and Latib، نويسنده , , Azeem and Park، نويسنده , , Seung-Jung and Kim، نويسنده , , Young Hak and Onuma، نويسنده , , Yoshinobu and Capranzano، نويسنده , , Piera and Jegere، نويسنده , , Sanda and Makkar، نويسنده , , Raj and Palacios، نويسنده , , Igor and Buszman، نويسنده , , Pawel and Chakravarty، نويسنده , , Tarun and Mehran، نويسنده , , Roxana and Naber، نويسنده , , Christoph and Margey، نويسنده , , Ronan and Leon، نويسنده , , Martin and Moses، نويسنده , , Jeffrey and Fajadet، نويسنده , , Jean-Françis Lefèvre، نويسنده , , Thierry and Morice، نويسنده , , Marie-Claude and Erglis، نويسنده , , Andrejs and Tamburino، نويسنده , , Corrado and Alfieri، نويسنده , , Ottavio and DʹAmico، نويسنده , , Maurizio and Marra، نويسنده , , Sebastiano and Serruys، نويسنده , , Patrick W. and Colombo، نويسنده , , Antonio and Meliga، نويسنده , , Emanuele، نويسنده ,
Abstract :
Percutaneous coronary intervention (PCI) with drug-eluting stents is an accepted alternative to surgery for the treatment of unprotected left main coronary artery (ULMCA) disease, but the long-term outcome in elderly patients is unclear. Aim of our study was to compare the clinical outcomes of octogenarians with ULMCA disease treated either with PCI with drug-eluting stents or coronary artery bypass grafting (CABG). The primary study end point was the composite of death, cerebrovascular accident, and myocardial infarction at follow-up. A total of 304 consecutive patients with ULMCA stenosis treated with PCI or CABG and aged ≥80 years were selected and analyzed in a large multinational registry. Two hundred eighteen were treated with PCI and 86 with CABG. During the hospitalization, a trend toward a higher mortality rate was reported in PCI-treated patients (3.5% vs 7.3%, p = 0.32). At a median follow-up of 1,088 days, the incidence of the primary end point was similar in the 2 groups (32.6% vs 30.2%, p = 0.69). Incidence of target vessel revascularization at follow-up was higher in PCI-treated patients (10% vs 4.2%, p = 0.05). At multivariate analysis, left ventricular ejection fraction was the only independent predictor of the primary end point (hazard ratio 0.95, 95% confidence interval 0.91 to 0.98, p = 0.001). After adjustment with propensity score, the revascularization strategy was not significantly correlated to the incidence of the primary end point (hazard ratio 0.98, 95% confidence interval 0.57 to 1.71, p = 0.95). In octogenarians, no difference was observed in the occurrence of the primary end point after PCI or CABG for the treatment of ULMCA disease. However, the rate of target vessel revascularization was higher in the PCI group.
