Key result
Coronary artery bypass grafting did not significantly reduce 5-year overall mortality compared to medical therapy in octogenarians with multi-vessel coronary artery disease (22% vs 36%, p=0.186).
Why the study?
Does coronary artery bypass grafting improve outcomes in octogenarian patients with multi-vessel coronary artery disease compared to medical therapy?
Cohort (n=100)
No
Does coronary artery bypass grafting improve outcomes in octogenarian patients with multi-vessel coronary artery disease compared to medical therapy?
Absolute Event Rate: 22% vs 36%
p-value: p=0.186
In octogenarians with multi-vessel CAD, CABG provides significant long-term symptomatic and functional benefits over medical therapy, despite higher short-term morbidity and no statistically significant difference in 5-year mortality.
Should not yet change practice for survival in octogenarians; leaves open symptomatic benefits pending randomized trials.
BACKGROUND: Appropriate treatment methods lead to a reduced rate of mortality and morbidity, and an improved quality of life, in patients with multi-vessel coronary artery disease. OBJECTIVES: In this study, we compared short and long-term outcomes of coronary artery bypass grafting (CABG) versus medical therapy in patients 80 years of age and older with multi-vessel coronary artery disease (MVCAD). PATIENTS AND METHODS: In this retrospective study, 50 octogenarian patients with MVCAD who underwent CABG were compared with 50 patients in the same condition who were treated with medical therapy during the same time. The primary objective was to compare mortality and morbidity rates, as well as other factors such as the occurrence of chest pain, deterioration of the NYHA functional class, and re-hospitalization, between the two groups. The comparison was made using medical records from the five years post-treatment. RESULTS: After five years, the overall mortality rate included 11 patients (22%) in the CABG group versus 18 patients (36%) in the medical therapy group; this difference was not significant between the two groups (P = 0.186). Regarding short-term outcomes, in the CABG group, cardiogenic shock occurred in 9 patients (18%), renal failure in 13 patients (26%), pulmonary complications in 9 patients (18%) and neurologic complications in 3 patients (6%); in the medical therapy group, these same complications occurred, respectively, in 6 patients (12%), 7 patients (14%), 10 patients (20%) and 1 patient (2%). In addition to these factors, freedom from chest pain and improvement in the functional class among the CABG group was significantly higher than among the medical therapy group (P = <0.001). CONCLUSIONS: CABG may be the superior form of treatment for long-term outcomes in terms of the relief of chest pain, improvement of the functional class, reduced need for re-admission, and later death for octogenarians. However, short-term morbidity may be higher among the CABG group, but the mortality rate after 30 days is quite similar.
No takes yet. Share an insight, caveat, or question.
Sohrabi et al. (2015) conducted a cohort in Multi-vessel coronary artery disease (n=100). Coronary artery bypass grafting (CABG) vs. Medical therapy was evaluated on Overall mortality rate at 5 years (p=0.186). Coronary artery bypass grafting did not significantly reduce 5-year overall mortality compared to medical therapy in octogenarians with multi-vessel coronary artery disease (22% vs 36%, p=0.186).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: