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Am J Cardiol. 2014 Jun 15;113(12):2007-12. doi: 10.1016/j.amjcard.2014.03.044. Epub 2014 Apr 1.

Long-term outcomes of percutaneous coronary interventions or coronary artery bypass grafting for left main coronary artery disease in octogenarians (from a Drug-Eluting stent for LefT main Artery registry substudy).

Author information

  • 1Department of Cardiology, Città della Salute e della Scienza Hospital, Turin, Italy. Electronic address: federico.conrotto@gmail.com.
  • 2Department of Cardiology, Città della Salute e della Scienza Hospital, Turin, Italy.
  • 3Division of Cardiology, Department of Internal Medicine, University of Turin, Turin, Italy.
  • 4Department of Cardio-Thoracic and Vascular Diseases, San Raffaele Scientific Institute, Milan, Italy.
  • 5Department of Cardiology, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
  • 6Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
  • 7Ferrarotto Hospital, University of Catania, Catania, Italy.
  • 8Latvian Centre of Cardiology, Pauls Stradins Clinical University Hospital, Riga, Latvia; Institute of Cardiology, University of Latvia, Riga, Latvia.
  • 9Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
  • 10Cardiac Catheterization Laboratory, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
  • 11American Heart of Poland, Medical University of Silesia, Katowice, Poland.
  • 12Columbia University Medical Center and Cardiovascular Research Foundation, New York, New York.
  • 13Department of Cardiology, University Hospital, Essen, Germany.
  • 14Clinique Pasteur, Toulouse, France.
  • 15Institut Hospitalier Jacques Cartier, Massy, France.
  • 16Interventional Cardiology Unit, A.O. Ordine Mauriziano Umberto I, Turin, Italy.


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.

Copyright © 2014 Elsevier Inc. All rights reserved.

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