Key result
Revascularization plus OMT was associated with lower cardiac mortality (7.0% vs 14.3%, P=0.04) but similar MACCE rates (27.3% vs 29.6%, P=0.67) compared to OMT alone in elderly men.
Why the study?
Does revascularization plus optimal medical therapy reduce cardiac mortality and MACCE compared to optimal medical therapy alone in high-risk elderly male patients with multivessel coronary disease?
Cohort (n=241)
Does revascularization plus optimal medical therapy reduce cardiac mortality and MACCE compared to optimal medical therapy alone in high-risk elderly male patients with multivessel coronary disease?
In high-risk elderly men with multivessel coronary disease, adding revascularization to optimal medical therapy reduced long-term cardiac mortality but did not significantly change overall MACCE rates.
Higher cardiac mortality with OMT alone in high-risk elderly angina; hypothesis-generating and should not change practice pending randomized confirmation.
BACKGROUND: Many studies have indicated that medical therapy and percutaneous coronary intervention have similar effects in terms of the long-term prognosis of patients with stable coronary artery disease. This study investigated the effects of optimal medical therapy (OMT) and revascularization-plus-OMT in elderly patients with high-risk angina. METHODS: In this prospective non-randomized study, 241 consecutive high-risk elderly male patients (65-92 years of age) with angiographically confirmed multivessel disease were enrolled in the registry from January 2004 to April 2005. Of these, 98 patients underwent OMT and 143 underwent revascularization therapy plus OMT. RESULTS: After 6.5 years of follow-up, we found that the rate of long-term cardiac mortality was significantly higher in patients who underwent OMT than in those who underwent revascularization (6.5-year unadjusted mortality rate, 14.3% for OMT vs. 7.0% for revascularization patients; log-rank P = 0.04). However, the overall risks of major adverse cardiac cerebrovascular events (MACCE) were similar among all patients (6.5-year unadjusted mortality rate, 29.6% for OMT vs. 27.3% for revascularization patients; log-rank P = 0.67). CONCLUSIONS: OMT was associated with an increase in cardiac death but a similar 6.5-year risk of MACCE compared with revascularization in high-risk elderly male patients with coronary multivessel disease.
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Tao et al. (2016) conducted a cohort in multivessel coronary disease (n=241). Revascularization therapy plus optimal medical therapy vs. Optimal medical therapy (OMT) was evaluated on long-term cardiac mortality (p=0.04). Revascularization plus OMT was associated with lower cardiac mortality (7.0% vs 14.3%, P=0.04) but similar MACCE rates (27.3% vs 29.6%, P=0.67) compared to OMT alone in elderly men.
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