Kyohei Yamaji1, Hiroki Shiomi1, Takeshi Morimoto1, Kenji Nakatsuma1, Toshiaki Toyota1, Koh Ono1, Yutaka Furukawa1, Yoshihisa Nakagawa1, Kazushige Kadota1, Kenji Ando1, Shinichi Shirai1, Tomoya Onodera1, Hirotoshi Watanabe1, Masahiro Natsuaki1, Ryuzo Sakata1, Michiya Hanyu1, Noboru Nishiwaki1, Tatsuhiko Komiya1, Takeshi Kimura2. 1. From Division of Cardiology (K.Y., K.A., S.S.) and Division of Cardiovascular Surgery (M.H.), Kokura Memorial Hospital, Kitakyushu, Japan; Department of Cardiovascular Medicine (H.S., K.N., T.T., K.O., H.W., T. Kimura) and Department of Cardiovascular Surgery (R.S.), Kyoto University Graduate School of Medicine, Japan; Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan (T.M.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan (Y.F.); Division of Cardiology, Tenri Hospital, Japan (Y.N.); Department of Cardiology (K.K.) and Division of Cardiovascular Surgery (T. Komiya), Kurashiki Central Hospital, Japan; Division of Cardiology, Shizuoka City Shizuoka Hospital, Japan (T.O.); Division of Cardiology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan (M.N.); and Division of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine, Nara, Japan (N.N.). 2. From Division of Cardiology (K.Y., K.A., S.S.) and Division of Cardiovascular Surgery (M.H.), Kokura Memorial Hospital, Kitakyushu, Japan; Department of Cardiovascular Medicine (H.S., K.N., T.T., K.O., H.W., T. Kimura) and Department of Cardiovascular Surgery (R.S.), Kyoto University Graduate School of Medicine, Japan; Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan (T.M.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan (Y.F.); Division of Cardiology, Tenri Hospital, Japan (Y.N.); Department of Cardiology (K.K.) and Division of Cardiovascular Surgery (T. Komiya), Kurashiki Central Hospital, Japan; Division of Cardiology, Shizuoka City Shizuoka Hospital, Japan (T.O.); Division of Cardiology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan (M.N.); and Division of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine, Nara, Japan (N.N.). taketaka@kuhp.kyoto-ua.ac.jp.
Abstract
BACKGROUND: Age and sex are important considerations in the choice between percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in daily clinical practice. METHODS AND RESULTS: Of 25 816 patients enrolled in the multicenter Coronary Revascularization Demonstrating Outcome Study in Kyoto (CREDO-Kyoto; Cohort-1, n=9877; Cohort-2, n=15 939), the present study population consisted of 5651 patients (men, n=3998; women, n=1653) with triple-vessel coronary artery disease who were considered to be pertinent in comparisons of PCI with CABG (PCI, n=3165; CABG, n=2486). Patients were divided into 3 groups according to the tertiles of age: ≤65 years (n=1972), 66 to 73 years (n=1820), and ≥74 years (n=1859). The excess adjusted mortality risk of PCI relative to CABG was significant in patients ≥74 years of age (hazard ratio [HR], 1.40; 95% confidence interval [CI], 1.10-1.79; P=0.006), whereas the risks were neutral in patients ≤65 years of age (HR, 1.05; 95% CI, 0.73-1.53; P=0.78) and in patients 66 to 73 years of age (HR, 1.03; 95% CI, 0.78-1.36; P=0.85; interaction P=0.003). The excess mortality risk of PCI relative to CABG was significant in men (HR, 1.24; 95% CI, 1.03-1.50; P=0.02) and trended to be significant in women (HR, 1.34; 95% CI, 0.98-1.84; P=0.07) without significant interaction between sex and the mortality risk of PCI relative to CABG (interaction P=0.40). CONCLUSIONS: There was a significant association between age and the mortality risk of PCI relative to CABG with excess risk in patients ≥74 years of age and neutral risk in younger patients. There was no significant sex-related difference in the mortality risk of PCI relative to CABG.
BACKGROUND: Age and sex are important considerations in the choice between percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in daily clinical practice. METHODS AND RESULTS: Of 25 816 patients enrolled in the multicenter Coronary Revascularization Demonstrating Outcome Study in Kyoto (CREDO-Kyoto; Cohort-1, n=9877; Cohort-2, n=15 939), the present study population consisted of 5651 patients (men, n=3998; women, n=1653) with triple-vessel coronary artery disease who were considered to be pertinent in comparisons of PCI with CABG (PCI, n=3165; CABG, n=2486). Patients were divided into 3 groups according to the tertiles of age: ≤65 years (n=1972), 66 to 73 years (n=1820), and ≥74 years (n=1859). The excess adjusted mortality risk of PCI relative to CABG was significant in patients ≥74 years of age (hazard ratio [HR], 1.40; 95% confidence interval [CI], 1.10-1.79; P=0.006), whereas the risks were neutral in patients ≤65 years of age (HR, 1.05; 95% CI, 0.73-1.53; P=0.78) and in patients 66 to 73 years of age (HR, 1.03; 95% CI, 0.78-1.36; P=0.85; interaction P=0.003). The excess mortality risk of PCI relative to CABG was significant in men (HR, 1.24; 95% CI, 1.03-1.50; P=0.02) and trended to be significant in women (HR, 1.34; 95% CI, 0.98-1.84; P=0.07) without significant interaction between sex and the mortality risk of PCI relative to CABG (interaction P=0.40). CONCLUSIONS: There was a significant association between age and the mortality risk of PCI relative to CABG with excess risk in patients ≥74 years of age and neutral risk in younger patients. There was no significant sex-related difference in the mortality risk of PCI relative to CABG.
Authors: Lauren V Huckaby; Laura M Seese; Ibrahim Sultan; Thomas G Gleason; Yisi Wang; Floyd Thoma; Arman Kilic Journal: Ann Thorac Surg Date: 2020-03-19 Impact factor: 5.102
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