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J Thorac Cardiovasc Surg. 2015 Feb;149(2):479-84. doi: 10.1016/j.jtcvs.2014.10.032. Epub 2014 Oct 15.

Survival probability loss from percutaneous coronary intervention compared with coronary artery bypass grafting across age groups.

Author information

1
Department of Cardiac Surgery, Harefield Hospital, London, United Kingdom. Electronic address: umberto.benedetto@hotmail.com.
2
Department of Cardiac Surgery, Harefield Hospital, London, United Kingdom.
3
Department of Cardiology, Harefield Hospital, London, United Kingdom.

Abstract

BACKGROUND:

Whether the survival benefit from coronary artery bypass grafting (CABG), compared with percutaneous coronary intervention (PCI), for multivessel disease extends to the older segment of the population remains unclear. We aimed to investigate whether the effect on survival of PCI compared with CABG is related to the age of the patient.

METHODS:

Propensity score-matching analysis was conducted on 6723 patients (PCI = 1097, CABG = 5626) with multivessel coronary artery disease. In the PCI group, drug-eluting stents were used in 917 (83.5%) patients; bare metal stents were used in only 180 patients (16.5%). Nonparametric, bootstrap, point-wise confidence limits were obtained for PCI:CABG odds and hazard ratios for early (within 12 months) and late hazard phase (beyond 12 months) for a variety of age groups.

RESULTS:

After a mean follow-up time of 5.5 ± 3.2 years, a total of 301 deaths were recorded in the matched sample (208 in the PCI group and 93 in the CABG group). Overall survival was 95% ± 0.6% versus 95% ± 0.6% at 1 year, 84% ± 1.0% versus 92.4% ± 0.8% at 5 years, and 75% ± 1.6% versus 90% ± 1.0% at 8 years, for the PCI and CABG groups, respectively (log rank P < .001). PCI did not confer any significant benefit compared with CABG during the early hazard phase (within 12 months), but the survival-probability loss from PCI compared with CABG during the late hazard phase was present across all age groups. The hazard ratio declined from 3.8 to 3.4 and was statistically significant (lower limit >1 across all ages, ranging from 1.5 to 2.4).

CONCLUSIONS:

Compared with PCI, CABG leads to a significant reduction in late-phase mortality across all age groups.

Comment in

PMID:
25454918
DOI:
10.1016/j.jtcvs.2014.10.032
[Indexed for MEDLINE]
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