Francesco Nicolini1, Giovanni Andrea Contini2, Daniela Fortuna3, Davide Pacini4, Davide Gabbieri5, Luigi Vignali6, Gianluca Campo7, Antonio Manari8, Claudio Zussa9, Paolo Guastaroba3, Rossana De Palma3, Tiziano Gherli10. 1. Cardiac Surgery Unit, Clinical and Experimental Medicine Department, University of Parma, Parma, Italy. Electronic address: francesco.nicolini@unipr.it. 2. Cardiac Surgery Unit, Cardio-Nephro-Pulmonary Department, Parma Hospital, Parma, Italy. 3. Regional Agency for Health and Social Care, Emilia-Romagna Region, Bologna, Italy. 4. Cardio-Thoracic-Vascular Department, University Hospital S. Orsola-Malpighi, Bologna, Italy. 5. Clinical Surgical Cardiology and Thoracic Vascular Department, Hesperia Hospital, Modena, Italy. 6. Cardiology Unit, Cardio-Nephro-Pulmonary Department, Parma Hospital, Parma, Italy. 7. Cardiology Department, University Hospital of Ferrara, Ferrara, Italy. 8. Cardiology Department, S. Maria Nuova Hospital, Reggio Emilia, Italy. 9. Department of Cardiology and Cardiac Surgery, Villa Maria Cecilia Hospital, Lugo, Italy. 10. Cardiac Surgery Unit, Clinical and Experimental Medicine Department, University of Parma, Parma, Italy.
Abstract
BACKGROUND: The aim of this study was to compare 7-year rates of all-cause death, cardiac death, myocardial infarction, target vessel revascularization, and stroke in a large cohort of octogenarians with left main coronary artery or multivessel disease, treated with coronary artery bypass grafting or percutaneous coronary intervention. METHODS: Two propensity score-matched cohorts of patients undergoing revascularization procedures at regional public and private centers of Emilia-Romagna, Italy, from July 2002 to December 2008 were used to compare long-term outcomes of percutaneous coronary intervention (947 patients) and coronary artery bypass grafting (441 patients). RESULTS: There were no significant differences between groups in 30-day mortality. In the follow-up the overall and the matched percutaneous coronary intervention population experienced significantly worse outcomes in terms of cardiac mortality, myocardial infarction, and target vessel revascularization. No difference was found for stroke between treatment groups. Percutaneous coronary intervention was an independent predictor of increased death at long-term follow-up. The subgroups in which coronary artery bypass grafting reduced more clearly the risk of death were age 80 to 85 years, previous myocardial infarction, history of cardiac heart failure, chronic renal failure, peripheral vascular disease, and patients with three-vessel disease associated with the left main coronary artery. CONCLUSIONS: In this real-world setting, surgical coronary revascularization remains the standard of care for patients with left main or multivessel disease. The long-term outcomes of current percutaneous coronary intervention technology in octogenarians are yet to be determined with adequately powered prospective randomized studies.
BACKGROUND: The aim of this study was to compare 7-year rates of all-cause death, cardiac death, myocardial infarction, target vessel revascularization, and stroke in a large cohort of octogenarians with left main coronary artery or multivessel disease, treated with coronary artery bypass grafting or percutaneous coronary intervention. METHODS: Two propensity score-matched cohorts of patients undergoing revascularization procedures at regional public and private centers of Emilia-Romagna, Italy, from July 2002 to December 2008 were used to compare long-term outcomes of percutaneous coronary intervention (947 patients) and coronary artery bypass grafting (441 patients). RESULTS: There were no significant differences between groups in 30-day mortality. In the follow-up the overall and the matched percutaneous coronary intervention population experienced significantly worse outcomes in terms of cardiac mortality, myocardial infarction, and target vessel revascularization. No difference was found for stroke between treatment groups. Percutaneous coronary intervention was an independent predictor of increased death at long-term follow-up. The subgroups in which coronary artery bypass grafting reduced more clearly the risk of death were age 80 to 85 years, previous myocardial infarction, history of cardiac heart failure, chronic renal failure, peripheral vascular disease, and patients with three-vessel disease associated with the left main coronary artery. CONCLUSIONS: In this real-world setting, surgical coronary revascularization remains the standard of care for patients with left main or multivessel disease. The long-term outcomes of current percutaneous coronary intervention technology in octogenarians are yet to be determined with adequately powered prospective randomized studies.
Authors: Francesco Nicolini; Daniela Fortuna; Giovanni Andrea Contini; Davide Pacini; Davide Gabbieri; Claudio Zussa; Rossana De Palma; Antonella Vezzani; Tiziano Gherli Journal: Biomed Res Int Date: 2017-12-20 Impact factor: 3.411
Authors: Jessica G Y Luc; Michelle M Graham; Colleen M Norris; Sadek Al Shouli; Yugmel S Nijjar; Steven R Meyer Journal: BMC Cardiovasc Disord Date: 2017-11-02 Impact factor: 2.298
Authors: M E Gimbel; L M Willemsen; M C Daggelders; J C Kelder; T Oirbans; K F Beukema; E J Daeter; J M Ten Berg Journal: Neth Heart J Date: 2020-09 Impact factor: 2.380