Ben-Gal Yanai, Finkelstein Ariel, Banai Shmuel, Medalion Benjamin, Weisz Giora, Genereux Philippe, Moshe Shelly, Pevni Dmitry, Aviram Galit, Uretzky Gideon
Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.
Heart Surg Forum. 2012 Aug;15(4):E204-9. doi: 10.1532/HSF98.20111190.
Our goal was to compare the clinical outcomes of octogenarian (or older) patients who are referred for either surgical or percutaneous coronary revascularization.
We retrospectively evaluated the outcomes of all patients 80 years of age who had undergone coronary artery bypass grafting (CABG) with an internal mammary artery or had undergone a percutaneous coronary intervention (PCI) with a sirolimus-eluting stent to the left anterior descending artery in our center between May 2002 and December 2006.
Of the 301 patients, 120 underwent a PCI, and 181 underwent CABG. Surgical patients had higher rates of left main disease, triple-vessel disease, peripheral vascular disease, emergent procedures, and previous myocardial infarctions (39.7% versus 3.3% [P = .001], 76.1% versus 28.3% [P = .0001], 19.6% versus 7.5% [P = .004], 15.8% versus 2.5% [P = .0001], and 35.9% versus 25% [P = .04], respectively). CABG patients had a higher early mortality rate (9.9% versus 2.5%, P = .01). There were no differences in 1- and 4-year actuarial survival rates, with rates of 90% and 68%, respectively, for the PCI group and 85% and 71% for the CABG group (P = .85). The rates of actuarial freedom from major adverse cardiac events (MACEs) at 1 and 4 years were 83% and 75%, respectively, for the PCI group, and 86% and 78% for the CABG group (P = .33). The respective rates of freedom from reintervention were 87% and 83% for the PCI group, versus 99% and 97% for the CABG group (P < .001). The 4-year rate of freedom from recurring angina was 58% for the PCI group, versus 88% for CABG patients (P < .001). Revascularization strategy was not a predictor of adverse outcome in a multivariable analysis.
Octogenarian CABG patients were sicker and experienced a higher rate of early mortality. The 2 strategies had similar rates of late mortality and MACEs, with fewer reinterventions and recurring angina occurring following surgery.
我们的目标是比较接受外科或经皮冠状动脉血运重建的八旬（或以上）患者的临床结局。
我们回顾性评估了2002年5月至2006年12月期间在我们中心接受冠状动脉搭桥术（CABG）并使用乳内动脉或接受经皮冠状动脉介入治疗（PCI）并在左前降支置入西罗莫司洗脱支架的所有80岁患者的结局。
在301例患者中，120例接受了PCI，181例接受了CABG。外科手术患者的左主干病变、三支血管病变、外周血管疾病、急诊手术和既往心肌梗死发生率更高（分别为39.7%对3.3%[P = .001]，76.1%对28.3%[P = .0001]，19.6%对7.5%[P = .004]，15.8%对2.5%[P = .0001]，以及35.9%对25%[P = .04]）。CABG患者的早期死亡率更高（9.9%对2.5%，P = .01）。1年和4年精算生存率无差异，PCI组分别为90%和68%，CABG组分别为85%和71%（P = .85）。PCI组1年和4年无主要不良心脏事件（MACE）的精算发生率分别为83%和75%，CABG组分别为86%和78%（P = .33）。PCI组再次干预的无事件发生率分别为87%和83%，CABG组分别为99%和97%（P < .001）。PCI组4年复发性心绞痛的无事件发生率为58%，CABG患者为88%（P < .001）。在多变量分析中，血运重建策略不是不良结局的预测因素。
八旬CABG患者病情更重，早期死亡率更高。两种策略的晚期死亡率和MACE发生率相似，手术后再次干预和复发性心绞痛较少。
