In patients ≥80 years with ischemic heart disease, CABG and PCI were associated with greater 4-year survival (77.4% and 71.6%, respectively) compared to medical therapy (60.3%).
Cohort (n=21,573)
Yes
Does CABG or PCI improve survival compared to medical therapy in elderly patients with ischemic heart disease?
Elderly patients (≥80 years) with ischemic heart disease derive a paradoxically greater absolute survival benefit from surgical or percutaneous revascularization compared to medical therapy than younger patients.
Absolute Risk Reduction: 17
Absolute Event Rate: 77.4% vs 60.3%
Absolute Risk Reduction: 17%
BACKGROUND: Elderly patients with ischemic heart disease are increasingly referred for coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). However, reports of poor outcomes in the elderly have led to questions about the benefit of these strategies. We studied survival by prescribed treatment (CABG, PCI, or medical therapy) for patients in 3 age categories: or =80 years of age. METHODS AND RESULTS: The Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease (APPROACH) is a clinical data collection and outcome monitoring initiative capturing all patients undergoing cardiac catheterization and revascularization in the province of Alberta, Canada, since 1995. Characteristics and long-term outcomes of a cohort of >6000 elderly patients with ischemic heart disease were compared with younger patients. In 15 392 patients >70 years of age, 4-year adjusted actuarial survival rates for CABG, PCI, and medical therapy were 95.0%, 93.8%, and 90.5%, respectively. In 5198 patients 70 to 79 years of age, survival rates were 87.3%, 83.9%, and 79.1%, respectively. In 983 patients > or = 80 years of age, survival was 77.4% for CABG, 71.6% for PCI, and 60.3% for medical therapy. Absolute risk differences in comparison to medical therapy for CABG (17.0%) and PCI (11.3%) were greater for patients > or =80 years of age than for younger patients. CONCLUSIONS: Elderly patients paradoxically have greater absolute risk reductions associated with surgical or percutaneous revascularization than do younger patients. The combination of these results with a recent randomized trial suggests that the benefits of aggressive revascularization therapies may extend to subsets of patients in older age groups.
Graham et al. (2002) conducted a cohort in Ischemic heart disease (n=21,573). Coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) vs. Medical therapy was evaluated on 4-year adjusted actuarial survival (Absolute risk difference 17.0%). In patients ≥80 years with ischemic heart disease, CABG and PCI were associated with greater 4-year survival (77.4% and 71.6%, respectively) compared to medical therapy (60.3%).