Ten-year outcomes of patients randomized to surgery, angioplasty, or medical treatment for stable multivessel coronary disease: effect of age in the Medicine, Angioplasty, or Surgery Study II trial.

Abstract

OBJECTIVE:

With progressive aging, coronary artery disease has been diagnosed at more advanced ages. Although patients aged 65 years or more have been referred to surgical or percutaneous coronary interventions, the best option for coronary artery disease treatment remains uncertain. The current study compared the 3 treatment options for coronary artery disease in patients aged 65 years or more and analyzed the impact of age in treatment options.

METHODS:

Patients were separated according to age: 65 years or more (n = 200) and less than 65 years (n = 411). All patients were followed for 10 years. The rates of overall mortality, acute myocardial infarction, and new revascularizations were analyzed.

RESULTS:

Of 200 patients aged 65 years or more, 68 were randomized to medical therapy, 68 were randomized to percutaneous coronary intervention, and 64 were randomized to coronary artery bypass grafting. At 10 years, overall survival was 63% (medical therapy), 69% (percutaneous coronary intervention), and 66% (coronary artery bypass grafting) (P = .93). The survival free of combined events was 43% (medical therapy), 38% (percutaneous coronary intervention ), and 66% (coronary artery bypass grafting) (P = .007). The survival free of myocardial infarction was 82% (medical therapy), 77% (percutaneous coronary intervention), and 90% (coronary artery bypass grafting) (P = .17), and survival free of new revascularizations was 59% (medical therapy), 58% (percutaneous coronary intervention ), and 91% (coronary artery bypass grafting) (P = .0003). When the 2 age groups were compared, survival free of myocardial infarction for patients treated by percutaneous coronary intervention was 77% (older patients) and 92% (younger patients) (P = .004).

CONCLUSIONS:

In this analysis, treatment options for patients aged 65 years or more who have coronary artery disease yield similar overall survival. However, coronary artery bypass grafting was associated with fewer coronary events, and percutaneous coronary intervention was associated with a higher incidence of myocardial infarction.

• Authors: Paulo Cury Rezende, Whady Hueb, Cibele Larrosa Garzillo, Eduardo Gomes Lima, Alexandre Ciappina Hueb, José Antonio Franchini Ramires, Roberto Kalil Filho
• Journal: The Journal of thoracic and cardiovascular surgery (J Thorac Cardiovasc Surg) Vol. 146 Issue 5 Pg. 1105-12 (Nov 2013) ISSN: 1097-685X [Electronic] United States
• PMID: 22944095 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2013 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

Chemical References

• Cardiovascular Agents

Topics

• Age Factors
• Aged
• Angioplasty, Balloon, Coronary (adverse effects, mortality)
• Brazil
• Cardiovascular Agents (adverse effects, therapeutic use)
• Chi-Square Distribution
• Coronary Artery Bypass (adverse effects, mortality)
• Coronary Artery Disease (complications, diagnosis, mortality, therapy)
• Disease-Free Survival
• Female
• Humans
• Kaplan-Meier Estimate
• Male
• Multivariate Analysis
• Myocardial Infarction (etiology, mortality, therapy)
• Proportional Hazards Models
• Prospective Studies
• Risk Factors
• Time Factors
• Treatment Outcome