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Kirov H, Caldonazo T, Riedel LL, Tasoudis P, Moschovas A, Diab M, Färber G, Doenst T. Comparing outcomes between coronary artery bypass grafting and percutaneous coronary intervention in octogenarians with left main or multivessel disease. Sci Rep 2023; 13:22323. [PMID: 38102297 PMCID: PMC10724226 DOI: 10.1038/s41598-023-49069-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 12/04/2023] [Indexed: 12/17/2023] Open
Abstract
Mechanisms of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) differ as CABG provides surgical collateralization and may prolong life by preventing future myocardial infarctions (MI). However, CABG benefits are unclear in octogenarians, where surgical risk is often perceived as higher and PCI is chosen more liberally. We performed a meta-analysis of studies comparing outcomes in octogenarians with left main or multivessel disease who underwent CABG or PCI. Primary outcome was late mortality (> 5 years). Secondary outcomes were perioperative mortality, MI, re-revascularization (R-R), acute renal failure (ARF), and stroke. Fourteen studies with 17,942 patients were included. CABG was associated with lower late mortality (hazard ratio, HR: 1.23, 95% confidence interval: CI 1.05-1.44, p < 0.01). In the pooled Kaplan-Meier analysis CABG showed significantly lower risk of death in the follow-up compared to PCI (HR: 1.08, 95%CI 1.02-1.41, p = 0.005). Landmark analyses confirmed the survival advantage of CABG over PCI after 21.5 months of follow-up (HR: 1.31, 1.19-1.44, p < 0.0001), but suggested advantage of PCI over CABG in the first 30-days (HR: 0.72, 0.64-0.82, p < 0.0001) and comparable survival from 1 to 21.5 months (HR: 0.98, 0.92-1.05, p = 0.652). We found lower risk for MI and R-R after CABG but higher perioperative mortality and no differences in ARF and stroke. CABG appears superior to PCI over time in octogenarians with complex CAD. This survival advantage is associated with fewer events of MI and R-R; however, it comes with an increased risk in perioperative mortality.
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Affiliation(s)
- Hristo Kirov
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University, Jena, Germany
| | - Tulio Caldonazo
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University, Jena, Germany
| | - Leoni Lu Riedel
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University, Jena, Germany
| | - Panagiotis Tasoudis
- Division of Cardiothoracic Surgery, University of North Carolina, Chapel Hill, USA
| | - Alexandros Moschovas
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University, Jena, Germany
| | - Mahmoud Diab
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University, Jena, Germany
| | - Gloria Färber
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University, Jena, Germany
| | - Torsten Doenst
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University, Jena, Germany.
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany.
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Hachiro K, Suzuki T, Takashima N, Kamiya K. Off-Pump Bilateral Skeletonized Internal Thoracic Artery Grafting in Octogenarians. Circ J 2023; 87:312-319. [PMID: 36476828 DOI: 10.1253/circj.cj-22-0443] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND We compared postoperative outcomes in octogenarians who underwent off-pump isolated coronary artery bypass grafting for multivessel disease using either skeletonized bilateral or single internal thoracic artery (ITA).Methods and Results: Among 1,532 patients who underwent isolated coronary artery bypass grafting between 2002 and 2021, 173 octogenarians were analyzed retrospectively. After inverse probability of treatment weighting, we found no statistically significant difference regarding patients' preoperative characteristics. No patient experienced deep sternal wound infection. More patients in the single than bilateral ITA group died within 30 days after surgery (5.0% vs. 0%, respectively; P=0.003). The mean follow-up duration was 4.2 years. At 5 years, the freedom from overall death following bilateral versus single ITA grafting was 78.2% and 53.7%, respectively (log-rank test, P=0.003), and freedom from major adverse cardiac and cerebrovascular events (MACCE) was 67.9% and 44.8% respectively (log-rank test, P=0.002). In multivariable Cox models, bilateral ITA grafting was significantly associated with a lower risk of overall death (hazard ratio [HR] 0.555; 95% confidence interval [CI] 0.342-0.903; P=0.018) and MACCE (HR 0.586; 95% CI 0.376-0.913; P=0.018). CONCLUSIONS Compared with single ITA grafting, off-pump skeletonized bilateral ITA grafting is associated with lower rates of overall death and MACCE in octogenarians undergoing CABG and does not increase the risk of deep sternal wound infection.
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Affiliation(s)
- Kohei Hachiro
- Division of Cardiovascular Surgery, Department of Surgery, Shiga University of Medical Science
| | - Tomoaki Suzuki
- Division of Cardiovascular Surgery, Department of Surgery, Shiga University of Medical Science
| | - Noriyuki Takashima
- Division of Cardiovascular Surgery, Department of Surgery, Shiga University of Medical Science
| | - Kenichi Kamiya
- Division of Cardiovascular Surgery, Department of Surgery, Shiga University of Medical Science
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Dąbrowski EJ, Kożuch M, Dobrzycki S. Left Main Coronary Artery Disease-Current Management and Future Perspectives. J Clin Med 2022; 11:jcm11195745. [PMID: 36233613 PMCID: PMC9573137 DOI: 10.3390/jcm11195745] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 09/22/2022] [Accepted: 09/26/2022] [Indexed: 02/05/2023] Open
Abstract
Due to its anatomical features, patients with an obstruction of the left main coronary artery (LMCA) have an increased risk of death. For years, coronary artery bypass grafting (CABG) has been considered as a gold standard for revascularization. However, notable advancements in the field of percutaneous coronary intervention (PCI) led to its acknowledgement as an important treatment alternative, especially in patients with low and intermediate anatomical complexity. Although recent years brought several random clinical trials that investigated the safety and efficacy of the percutaneous approach in LMCA, there are still uncertainties regarding optimal revascularization strategies. In this paper, we provide a comprehensive review of state-of-the-art diagnostic and treatment methods of LMCA disease, focusing on percutaneous methods.
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Coerkamp CF, Hoogewerf M, van Putte BP, Appelman Y, Doevendans PA. Revascularization strategies for patients with established chronic coronary syndrome. Eur J Clin Invest 2022; 52:e13787. [PMID: 35403216 PMCID: PMC9539712 DOI: 10.1111/eci.13787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 04/03/2022] [Accepted: 04/04/2022] [Indexed: 11/28/2022]
Abstract
Coronary artery disease is the most common type of cardiovascular disease, leading to high mortality rates worldwide. Although the vast majority can be treated effectively and safely by medical therapy, revascularization strategies remain essential for numerous patients. Outcomes of both percutaneous coronary intervention and coronary artery bypass grafting improve in a rapid pace, resulting from technical innovation and ongoing research. Progress has been achieved by technical improvements in coronary stents, optimal coronary target and graft selection, and the availability of minimally invasive surgical strategies. Besides technical progress, evidence-based patient-tailored decision-making by the Heart Team is the basic precondition for optimal outcome. The combination of fast innovation and long-term clinical evaluations creates a dynamic field. Research outcomes should be carefully interpreted according to the techniques used and the trial's design. Therefore, more and more trial outcomes suggest that revascularization strategies should be tailored towards the specific patient. Although the European Society of Cardiology/European Association for Cardio-Thoracic Surgery guidelines on myocardial revascularization date from 2018 and a large variety of trial outcomes on revascularization strategies in chronic coronary syndrome have been published since, we aim to provide an updated overview within this review.
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Affiliation(s)
- Casper F Coerkamp
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Marieke Hoogewerf
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.,Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Bart P van Putte
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Yolande Appelman
- Department of Cardiology, Amsterdam UMC, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Pieter A Doevendans
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands.,Netherlands Heart Institute, Utrecht, The Netherlands
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Brown MA, Klusewitz S, Elefteriades J, Prescher L. The Current State of Coronary Revascularization: Percutaneous Coronary Intervention versus Coronary Artery Bypass Graft Surgery. Int J Angiol 2021; 30:228-242. [PMID: 34776823 DOI: 10.1055/s-0041-1735591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
The question of percutaneous coronary intervention (PCI) versus coronary artery bypass graft (CABG) surgery remains among the most important questions in the treatment of coronary artery disease. The leading North American and European societies largely agree on the current guidelines for the revascularization of unprotected left-main disease (ULMD) and multivessel disease (MVD) which are largely supported by the outcomes of several large randomized trials including SYNTAX, PRECOMBAT, NOBLE, and EXCEL. While these trials are of the highest quality, currently available, they suffer several limitations, including the use of bare metal and/or first-generation drug-eluting stents in early trials and lack of updated surgical outcomes data. The objective of this review is to briefly discuss these key early trials, as well as explore contemporary studies, to provide insight on the current state of coronary revascularization. Evidence suggests that in ULMD and MVD, there are similar mortality rates for CABG and PCI but PCI is associated with fewer "early" strokes, whereas CABG is associated with fewer "late" strokes, myocardial infarctions, and lower need for repeat revascularization. Additionally, studies suggest that CABG remains superior to PCI in patients with intermediate/high SYNTAX scores and in MVD with concomitant proximal left anterior descending (pLAD) artery stenosis. Despite the preceding research and its basis for our current guidelines, there remains significant variation in care that has yet to be quantified. Emerging studies evaluating second-generation drug-eluting stents, specific lesion anatomy, and minimally invasive and hybrid approaches to CABG may lend itself to more individualized patient care.
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Affiliation(s)
- Matthew A Brown
- Department of Cardiac Surgery, Georgetown University School of Medicine, Washington, District of Columbia
| | - Seth Klusewitz
- Department of Cardiology, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - John Elefteriades
- Department of Cardiac Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Lindsey Prescher
- Department of Cardiac Surgery, Yale University School of Medicine, New Haven, Connecticut
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Five-year outcomes after coronary artery bypass grafting and percutaneous coronary intervention in octogenarians with complex coronary artery disease. Gen Thorac Cardiovasc Surg 2021; 70:419-429. [PMID: 34613579 DOI: 10.1007/s11748-021-01711-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 09/13/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE We assessed the clinical effectiveness of coronary artery bypass grafting (CABG) in comparison with that of percutaneous coronary intervention (PCI) in octogenarians with triple-vessel disease (TVD) or left main coronary artery (LMCA) disease. METHODS From the CREDO-Kyoto registry cohort-2, 527 patients, who were ≥ 80 years of age and underwent the first coronary revascularization for TVD or LMCA disease, were divided into the CABG group (N = 151) and the PCI group (N = 376). RESULTS The median and interquartile range of patient's age was 82 (81-84) in the CABG group and 83 (81-85) in the PCI group (P = 0.10). Patients > = 85 years of age accounted for 19% and 31% in the CABG and PCI groups, respectively (P = 0.01). The cumulative 5-year incidence of all-cause death was similar between CABG and PCI groups (35.8% vs. 42.9%, log-rank P = 0.18), while CABG showed a lower rate of the composite of cardiac death/MI than PCI (21.7% vs. 33.9%, log-rank P = 0.005). After adjusting for confounders, the lower risk of CABG relative to PCI was significant for all-cause death (HR 0.61, 95% CI 0.43-0.86, P = 0.005), any coronary revascularization (HR 0.25, 95% CI 0.14-0.43, P < 0.001) and the composite of cardiac death/MI (HR 0.52, 95% CI 0.32-0.85, P = 0.009). CONCLUSIONS CABG compared with PCI was associated with a lower adjusted risk for all-cause death, any coronary revascularization, and a composite of cardiac death/MI in very elderly patients with TVD or LMCA disease. CABG seemed an acceptable option for selected octogenarians with severe coronary artery disease.
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Yuan D, Jia S, Zhang C, Jiang L, Xu L, Zhang Y, Xu J, Liu R, Xu B, Hui R, Gao R, Gao Z, Song L, Yuan J. Real-world long-term outcomes based on three therapeutic strategies in very old patients with three-vessel disease. BMC Cardiovasc Disord 2021; 21:316. [PMID: 34187370 PMCID: PMC8243749 DOI: 10.1186/s12872-021-02067-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 05/17/2021] [Indexed: 11/25/2022] Open
Abstract
Background There are relatively limited data regarding real-world outcomes in very old patients with three-vessel disease (3VD) receiving different therapeutic strategies. This study aimed to perform analysis of long-term clinical outcomes of medical therapy (MT), coronary artery bypass grafting (CABG), and percutaneous coronary intervention (PCI) in this population. Methods We included 711 patients aged ≥ 75 years from a prospective cohort of patients with 3VD. Consecutive enrollment of these patients began from April 2004 to February 2011 at Fu Wai Hospital. Patients were categorized into three groups (MT, n = 296; CABG, n = 129; PCI, n = 286) on the basis of different treatment strategies. Results During a median follow-up of 7.25 years, 262 deaths and 354 major adverse cardiac and cerebrovascular events (MACCE) occurred. Multivariate Cox analysis showed that the risk of cardiac death was significantly lower for CABG compared with PCI (adjusted hazard ratio [HR] = 0.475, 95% confidence interval [CI] 0.232–0.974, P = 0.042). Additionally, MACCE appeared to show a trend towards a better outcome for CABG (adjusted HR = 0.759, 95% CI 0.536–1.074, P = 0.119). Furthermore, CABG was significantly superior in terms of unplanned revascularization (adjusted HR = 0.279, 95% CI 0.079–0.982, P = 0.047) and myocardial infarction (adjusted HR = 0.196, 95% CI 0.043–0.892, P = 0.035). No significant difference in all-cause death between CABG and PCI was observed. MT had a higher risk of cardiac death than PCI (adjusted HR = 1.636, 95% CI 1.092–2.449, P = 0.017). Subgroup analysis showed that there was a significant interaction between treatment strategy (PCI vs. CABG) and sex for MACCE (P = 0.026), with a lower risk in men for CABG compared with that of PCI, but not in women. Conclusions CABG can be performed with reasonable results in very old patients with 3VD. Sex should be taken into consideration in therapeutic decision-making in this population. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-02067-6.
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Affiliation(s)
- Deshan Yuan
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 167, Beilishi Rd, Xicheng District, Beijing, 100037, China
| | - Sida Jia
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 167, Beilishi Rd, Xicheng District, Beijing, 100037, China
| | - Ce Zhang
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 167, Beilishi Rd, Xicheng District, Beijing, 100037, China
| | - Lin Jiang
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 167, Beilishi Rd, Xicheng District, Beijing, 100037, China
| | - Lianjun Xu
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 167, Beilishi Rd, Xicheng District, Beijing, 100037, China
| | - Yin Zhang
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 167, Beilishi Rd, Xicheng District, Beijing, 100037, China
| | - Jingjing Xu
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 167, Beilishi Rd, Xicheng District, Beijing, 100037, China
| | - Ru Liu
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 167, Beilishi Rd, Xicheng District, Beijing, 100037, China
| | - Bo Xu
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 167, Beilishi Rd, Xicheng District, Beijing, 100037, China
| | - Rutai Hui
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 167, Beilishi Rd, Xicheng District, Beijing, 100037, China
| | - Runlin Gao
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 167, Beilishi Rd, Xicheng District, Beijing, 100037, China
| | - Zhan Gao
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 167, Beilishi Rd, Xicheng District, Beijing, 100037, China
| | - Lei Song
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 167, Beilishi Rd, Xicheng District, Beijing, 100037, China.
| | - Jinqing Yuan
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 167, Beilishi Rd, Xicheng District, Beijing, 100037, China.
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Ono M, Serruys PW, Hara H, Kawashima H, Gao C, Wang R, Takahashi K, O'Leary N, Wykrzykowska JJ, Sharif F, Piek JJ, Garg S, Mack MJ, Holmes DR, Morice MC, Head SJ, Kappetein AP, Thuijs DJFM, Noack T, Davierwala PM, Mohr FW, Cohen DJ, Onuma Y. 10-Year Follow-Up After Revascularization in Elderly Patients With Complex Coronary Artery Disease. J Am Coll Cardiol 2021; 77:2761-2773. [PMID: 34082905 DOI: 10.1016/j.jacc.2021.04.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/23/2021] [Accepted: 04/01/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The optimal revascularization strategy for the elderly with complex coronary artery disease remains unclear. OBJECTIVES The goal of this study was to investigate 10-year all-cause mortality, life expectancy, 5-year major adverse cardiac or cerebrovascular events (MACCE), and 5-year quality of life (QOL) after percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) in elderly individuals (>70 years old) with 3-vessel disease (3VD) and/or left main disease (LMD). METHODS In the present pre-specified analysis on age of the SYNTAX Extended Survival study, 10-year all-cause death and 5-year MACCE were compared with Kaplan-Meier estimates and Cox proportional hazards models among elderly or nonelderly patients. Life expectancy was estimated by restricted mean survival time within 10 years, and QOL status according to the Seattle Angina Questionnaire up to 5 years was assessed by linear mixed-effects models. RESULTS Among 1,800 randomized patients, 575 patients (31.9%) were elderly. Ten-year mortality did not differ significantly between PCI and CABG in elderly (44.1% vs. 41.1%; hazard ratio [HR]: 1.08; 95% confidence interval [CI]: 0.84 to 1.40) and nonelderly patients (21.1% vs. 16.6%; HR: 1.30; 95% CI: 1.00 to 1.69; pinteraction = 0.332). Among elderly patients, 5-year MACCE was comparable between PCI and CABG (39.4% vs. 35.1%; HR: 1.18; 95% CI: 0.90 to 1.56), whereas it was significantly higher in PCI over CABG among nonelderly patients (36.3% vs. 23.0%; HR: 1.69; 95% CI: 1.36 to 2.10; pinteraction = 0.043). There were no significant difference in life expectancy (mean difference: 0.2 years in favor of CABG; 95% CI: -0.4 to 0.7) and 5-year QOL status between PCI and CABG among elderly patients. CONCLUSIONS Elderly patients with 3VD and/or LMD had comparable 10-year all-cause death, life expectancy, 5-year MACCE, and 5-year QOL status irrespective of revascularization mode. (Synergy Between PCI With TAXUS and Cardiac Surgery: SYNTAX Extended Survival [SYNTAXES]; NCT03417050) (SYNTAX Study: TAXUS Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the Treatment of Narrowed Arteries [SYNTAX]; NCT00114972).
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Affiliation(s)
- Masafumi Ono
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Patrick W Serruys
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland; NHLI, Imperial College London, London, United Kingdom.
| | - Hironori Hara
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Hideyuki Kawashima
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Chao Gao
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland; Department of Cardiology, Radboud University, Nijmegen, the Netherlands
| | - Rutao Wang
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland; Department of Cardiology, Radboud University, Nijmegen, the Netherlands
| | - Kuniaki Takahashi
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Neil O'Leary
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Joanna J Wykrzykowska
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; University Medical Center Groningen, Groningen, the Netherlands
| | - Faisal Sharif
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland; CÚRAM-SFI Centre for Research in Medical Devices, Galway, Ireland
| | - Jan J Piek
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Scot Garg
- Department of Cardiology, Royal Blackburn Hospital, Blackburn, United Kingdom
| | - Michael J Mack
- Department of Cardiothoracic Surgery, Baylor University Medical Center, Dallas, Texas, USA
| | - David R Holmes
- Department of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Marie-Claude Morice
- Département of Cardiologie, Hôpital privé Jacques Cartier, Générale de Santé Massy, France
| | - Stuart J Head
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Arie Pieter Kappetein
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Daniel J F M Thuijs
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Thilo Noack
- University Department of Cardiac Surgery, Heart Centre Leipzig, Leipzig, Germany
| | - Piroze M Davierwala
- University Department of Cardiac Surgery, Heart Centre Leipzig, Leipzig, Germany
| | - Friedrich W Mohr
- University Department of Cardiac Surgery, Heart Centre Leipzig, Leipzig, Germany
| | - David J Cohen
- Cardiovascular Research Foundation, New York, New York, USA; St. Francis Hospital, Roslyn, New York, USA
| | - Yoshinobu Onuma
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
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Is the Use of BITA vs SITA Grafting Safe and Beneficial in Octogenarians? Ann Thorac Surg 2021; 111:1998-2003. [DOI: 10.1016/j.athoracsur.2020.07.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 06/07/2020] [Accepted: 07/27/2020] [Indexed: 02/07/2023]
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Cui Z, Li N, Gao C, Fan Y, Zhuang X, Liu J, Zhang J, Tan Q. Precision implementation of early ambulation in elderly patients undergoing off-pump coronary artery bypass graft surgery: a randomized-controlled clinical trial. BMC Geriatr 2020; 20:404. [PMID: 33054724 PMCID: PMC7560239 DOI: 10.1186/s12877-020-01823-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 10/07/2020] [Indexed: 01/17/2023] Open
Abstract
Background Although early ambulation (EA) is associated with improved outcomes in post-operative patients, implementation of EA in elderly patients is still a challenge. In this study, we aimed to design and assess a precision early ambulation program for cardiac rehabilitation. Methods We conducted a single-center, randomized and controlled clinical trial in elderly patients aged over 60 years after off-pump coronary artery bypass graft (OPCABG) surgery. Patients were randomly assigned to a precision early ambulation (PEA) group or a routine ambulation (Control) group. Age-predicted maximal heart rate (APMHR) and maximal oxygen uptake (VO2max) were used as a reference to formulate and monitor the PEA regimen. The primary end-point was the postoperative length of stay in hospital (PLOS). The secondary end-points included 90-day mortality, incidence of early discharge, laboratory tests, length of ICU stay, the incidence of multiple organ complications and post-traumatic stress disorder (PTSD). Ambulation outcomes were also recorded. Results In total, 178 patients were enrolled (n = 89 per group). In the intent-to-treat analysis, PLOS in the PEA group was shorter than that in the Control group (9.04 ± 3.08 versus 10.09 ± 3.32 days, respectively. Mean difference 1.045 days; 95% confidence interval [CI] 0.098–1.992; P = 0.031 in the unadjusted model; mean difference 0.957 days; CI 0.007–1.907; P = 0.048 in adjusted model). The incidence of early discharge differed significantly between the PEA and control groups (41[46.1%] versus 24[27.0%] patients, respectively. Odds ratio [OR] 0.432; CI 0.231–0.809; P = 0.009 in unadjusted model; OR 0.466; CI 0.244–0.889, P = 0.02 in adjusted model). The time of first bowel movement, partial pressure O2 and post-traumatic stress disorder score in the PEA group were better than those in the Control group. Participants walked much longer distances on day 3 in the PEA group than those in the Control group (76.12 ± 29.02 versus 56.80 ± 24.40 m, respectively, P < 0.001). Conclusion APMHR and VO2max are valuable for implementation of PEA according to an established security threshold. PEA after OPCAPG surgery is safe and reliable for elderly patients, not only reducing the hospital stay, but also improving their physiological and psychological symptoms. Trial registration This study is a component of a protocol retrospectively registered: Application of ERAS in cardiovascular surgery. Trial registration number: ChiCTR1800018167. Date of registration: 3rd September, 2018. URL of trial registry record: http://www.chictr.org.cn/index.aspx
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Affiliation(s)
- Zhaomei Cui
- Intensive Care Unit (ICU), Department of Cardiac Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China
| | - Na Li
- Department of Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China
| | - Chaonan Gao
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
| | - Yiou Fan
- Department of Toxicological and Functional Test, Centers for Disease Control and Prevention of Shandong, Jinan, 250014, China
| | - Xin Zhuang
- Intensive Care Unit (ICU), Department of Cardiac Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China
| | - Jing Liu
- Intensive Care Unit (ICU), Department of Cardiac Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China
| | - Jie Zhang
- Intensive Care Unit (ICU), Department of Cardiac Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China
| | - Qi Tan
- Intensive Care Unit (ICU), Department of Cardiac Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China. .,Intensive Care Unit (ICU), Department of Cardiac Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250021, Shandong, China.
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11
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Ono M, Onuma Y, Serruys PW, Wykrzykowska JJ. Will coronary artery bypass grafting remain a standard of care for elderly patients with multivessel disease in the contemporary era? Neth Heart J 2020; 28:457-459. [PMID: 32737679 PMCID: PMC7431478 DOI: 10.1007/s12471-020-01477-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- M Ono
- Department of Cardiology, Heart Center, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Department of Cardiology, National University of Ireland Galway, Galway, Ireland
| | - Y Onuma
- Department of Cardiology, National University of Ireland Galway, Galway, Ireland.
| | - P W Serruys
- Department of Cardiology, National University of Ireland Galway, Galway, Ireland
- National Heart and Lung Institute, Imperial College London, London, UK
| | - J J Wykrzykowska
- Department of Cardiology, Heart Center, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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12
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Conrotto F, D'Ascenzo F, Piroli F, Franzé A, de Luca L, Quadri G, Ryan N, Escaned J, Bo M, De Ferrari GM. Percutaneous coronary intervention of unprotected left main and bifurcation in octogenarians: Subanalysis from RAIN (veRy thin stents for patients with left mAIn or bifurcatioN in real life). Catheter Cardiovasc Interv 2020; 97:755-763. [PMID: 32478451 DOI: 10.1002/ccd.29048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 05/15/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Outcomes of complex percutaneous coronary interventions (PCIs) in older patients are still debated. The aim of the study was to evaluate clinical outcomes of Octogenarian patients treated with ultrathinstents on left main or on coronary bifurcations, compared with younger patients. METHODS All consecutive patients presenting a critical lesion of an unprotected left main (ULM) or a bifurcation and treated with very thin stents were included in the RAIN (veRy thin stents for patients with left mAIn or bifurcatioN in real life) registry and divided into octogenarians group (OG, 551 patients) and nonoctogenarians (NOGs, 2,453 patients). Major adverse cardiovascular event (MACE), a composite end point of all-cause death, nonfatal myocardial infarction (MI), target lesion revascularization (TLR), and stent thrombosis (ST), was the primary endpoint, while MACE components, cardiovascular (CV) death, and target vessel revascularization (TVR) were the secondary ones. RESULTS Indication for PCI was acute coronary syndrome in 64.7% of the OG versus 53.1% of the NOG. Severe calcifications and a diffuse disease were significantly more in OG. After a follow-up of 15.2 ± 10.3 months, MACEs were higher in the OG than in the NOG patients (OG 19.1% vs. NOG 11.2%, p < .001), along with MI (OG 6% vs. NOG 3.4%, p = .002) and all-cause death (OG 14% vs. NOG 4.3%, p < .001). In contrast, no significant difference was detected in CV-death (OG 5.1% vs. NOG 4%, p = .871), TVR/TLR, or ST. At multivariate analysis, age was not an independent predictor of MACE (OR 1.02 CI 95% 0.76-1.38), while it was for all-cause death, along with diabetes, GFR < 60 ml/min, and ULM disease. DISCUSSION Midterm outcomes of complex PCI in OG are similar to those of younger patients. However, due to the higher non-CV death rate, accurate patient selection is mandatory.
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Affiliation(s)
- Federico Conrotto
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Torino, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Torino, Italy
| | - Francesco Piroli
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Torino, Italy
| | - Alfonso Franzé
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Torino, Italy
| | - Leonardo de Luca
- U.O.C. Cardiologia, Ospedale San Giovanni Evangelista, Rome, Italy
| | - Giorgio Quadri
- Department of Cardiology, Infermi Hospital, Turin, Italy
| | - Nicola Ryan
- Department of Cardiology, Hospital Clinico San Carlos, Madrid, Spain
| | - Javier Escaned
- Department of Cardiology, Hospital Clinico San Carlos, Madrid, Spain
| | - Mario Bo
- Division of Geriatrics, Department of Internal Medicine, Città della Salute e della Scienza, Torino, Italy
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Torino, Italy
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13
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Guo L, Lv HC, Huang RC. Percutaneous Coronary Intervention in Elderly Patients with Coronary Chronic Total Occlusions: Current Evidence and Future Perspectives. Clin Interv Aging 2020; 15:771-781. [PMID: 32546995 PMCID: PMC7264026 DOI: 10.2147/cia.s252318] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 05/11/2020] [Indexed: 12/23/2022] Open
Abstract
The proportion of the elderly in the total population of the world is growing, and the number of elderly patients with coronary chronic total occlusions (CTO) is huge. The elderly patients often have more extensive coronary artery disease, more severe ischemic burden and higher risk of cardiovascular events, as compared to younger patients, and thereby they might greatly benefit from coronary revascularization, even though they may have higher risk of operative complications. Most interventional cardiologists are more likely to be reluctant to operate complex percutaneous coronary intervention (PCI) in elderly patients. The latest refinements in dedicated CTO-PCI equipment and techniques have led to high rates of success and low complications rates and have made the CTO-PCI procedures safe and effective among the elderly patients. However, up to now, there is no widely recognized consensus or guideline on treatment strategy of elderly CTO patients, and the prognosis in this population is unknown. In this review, we aim to provide an overview of the current evidence and future perspectives on PCI in elderly patients with CTOs.
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Affiliation(s)
- Lei Guo
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China
| | - Hai-Chen Lv
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China
| | - Rong-Chong Huang
- Department of Cardiology, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, People's Republic of China
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14
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Gimbel ME, Willemsen LM, Daggelders MC, Kelder JC, Oirbans T, Beukema KF, Daeter EJ, Ten Berg JM. Long-term follow-up after bypass surgery or coronary stenting in elderly with multivessel disease. Neth Heart J 2020; 28:467-477. [PMID: 32333255 PMCID: PMC7431514 DOI: 10.1007/s12471-020-01415-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background We sought to compare long-term follow-up of coronary artery bypass grafting (CABG) with percutaneous coronary intervention (PCI) in elderly patients with left main or multivessel disease, hypothesising that completeness of revascularisation and severity of coronary artery disease are predictors of adverse outcomes. Methods Patients aged ≥75 years with multivessel disease or left main disease who underwent PCI or CABG between 2012–2016 were included in this retrospective cohort study. Baseline characteristics from the index procedure were collected. Severity of coronary artery disease and completeness of revascularisation were assessed. Primary outcome was all-cause mortality, in addition we captured major adverse cardiac and cerebral events, bleedings, recurrent angina and new onset atrial fibrillation. Results A total of 597 patients were included. Median follow-up was 4 years (interquartile range 2.8–5.3 years). At baseline, patients in the PCI group more often had a previous medical history of CABG and more frequently underwent an urgent procedure compared with patients in the CABG group. Mortality at 5‑year follow-up was significantly higher in patients who underwent PCI compared with CABG (39.9% vs 25.4%, p < 0.001). Furthermore, acute coronary syndrome (ACS), repeat revascularisation and recurrent angina occurred more frequently after PCI, while occurrence of bleedings and new onset atrial fibrillation were more frequent after CABG. Neither completeness of revascularisation nor severity of coronary artery disease was a predictor for any of the outcomes. Conclusion Long-term mortality was higher in elderly patients with multivessel disease undergoing PCI compared with CABG. In addition, patients undergoing PCI had a higher risk of ACS, repeat revascularisation and recurrent angina.
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Affiliation(s)
- M E Gimbel
- Department of Cardiology and Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.
| | - L M Willemsen
- Department of Cardiology and Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - M C Daggelders
- Department of Cardiology and Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - J C Kelder
- Department of Cardiology and Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - T Oirbans
- Department of Cardiology and Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - K F Beukema
- Department of Cardiology and Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - E J Daeter
- Department of Cardiology and Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - J M Ten Berg
- Department of Cardiology and Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
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15
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Affiliation(s)
- Sonali Kumar
- Division of Cardiology Department of Medicine Emory University Atlanta GA
| | - Michael McDaniel
- Division of Cardiology Department of Medicine Emory University Atlanta GA
| | - Habib Samady
- Division of Cardiology Department of Medicine Emory University Atlanta GA
| | - Farshad Forouzandeh
- Division of Cardiology Department of Medicine Emory University Atlanta GA.,Division of Cardiology Department of Medicine Case Western Reserve University Cleveland OH
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16
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He PP, Shen QQ, Chen YS, Yu J, Li ZX, Ouyang XP. Development and validation of a Chinese-language instrument measuring empowerment needs of patients after a percutaneous coronary intervention. Nurs Health Sci 2019; 22:364-373. [PMID: 31698541 DOI: 10.1111/nhs.12657] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 08/31/2019] [Accepted: 09/18/2019] [Indexed: 12/17/2022]
Abstract
Patient empowerment has been shown to have some positive impacts on self-efficacy, self-esteem, and recovery. However, information about the empowerment needs of patients after a percutaneous coronary intervention is scarce. The aim of this study was to develop a Chinese-language instrument to measure empowerment needs of such patients. The initial instrument was generated based on a literature review and interviews with patients after a percutaneous coronary intervention procedure. Content validity was tested with a panel of experts using the Delphi method. In total, 226 patients were recruited for psychometric tests using the revised instrument. Expert authority coefficient was 0.92, and content validity index was 0.95. The internal consistency reliability was demonstrated by Cronbach's α coefficients (0.86 for the total score, 0.66-0.74 for the dimensions). The newly developed 19-item, five-dimension instrument has shown satisfactory validity (face/content validity and construct validity) and internal consistency reliability. The instrument could help clinical nurses who have close contact with patients after a percutaneous coronary intervention to gain a better understanding of their empowerment needs and could help develop appropriate health education to address such needs.
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Affiliation(s)
- Ping-Ping He
- School of Nursing, University of South China, Hengyang, China.,Institute of Cardiovascular Disease, Key Laboratory for Arteriosclerology of Hunan Province, Hunan Province Cooperative innovation Center for Molecular Target New Drug Study, University of South China, Hengyang, China
| | - Qian-Qian Shen
- School of Nursing, University of South China, Hengyang, China
| | - Ye-Shi Chen
- School of Nursing, University of South China, Hengyang, China
| | - Juping Yu
- Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK
| | - Zhao-Xia Li
- School of Nursing, University of South China, Hengyang, China.,The People's Hospital of Pingyi Country, Linyi, China
| | - Xin-Ping Ouyang
- Institute of Cardiovascular Disease, Key Laboratory for Arteriosclerology of Hunan Province, Hunan Province Cooperative innovation Center for Molecular Target New Drug Study, University of South China, Hengyang, China.,Department of physiology, Institute of Neuroscience, Hengyang Key Laboratory of Neurodegeneration and Cognitive Impairment, Hunan province Cooperative Innovation Center for Molecular Target New Drug Research, Hengyang medical college, University of South China, Hengyang, China
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17
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Madhavan MV, Gersh BJ, Alexander KP, Granger CB, Stone GW. Coronary Artery Disease in Patients ≥80 Years of Age. J Am Coll Cardiol 2018; 71:2015-2040. [DOI: 10.1016/j.jacc.2017.12.068] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 12/14/2017] [Accepted: 12/19/2017] [Indexed: 02/07/2023]
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18
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The Impact of Age on Clinical Outcomes of Coronary Artery Bypass Grafting: Long-Term Results of a Real-World Registry. BIOMED RESEARCH INTERNATIONAL 2017; 2017:9829487. [PMID: 29423414 PMCID: PMC5750486 DOI: 10.1155/2017/9829487] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Revised: 09/26/2017] [Accepted: 10/19/2017] [Indexed: 11/17/2022]
Abstract
The aim of this retrospective multicenter registry study was to investigate age-dependent trends in mortality, long-term survival, and comorbidity over time in patients who underwent isolated CABG from 2003 to 2015. The percentage of patients < 60 years of age was 18.9%. Female sex, chronic pulmonary disease, extracardiac arteriopathy, and neurologic dysfunction disease were significantly less frequent in this younger population. The prevalence of BMI ≥ 30, previous myocardial infarction, preoperative severe depressed left ventricular ejection fraction, and history of previous PCI were significantly higher in this population. After PS matching, at 5 years, patients < 60 years of age reported significantly lower overall mortality (p < 0.0001), cardiac-related mortality (p < 0.0001), incidence of acute myocardial infarction (p = 0.01), and stroke rates (p < 0.0001). Patients < 60 years required repeated revascularization more frequently than older patients (p = 0.05). Patients < 60 who underwent CABG had a lower risk of adverse outcomes than older patients. Patients < 60 have a different clinical pattern of presentation of CAD in comparison with more elderly patients. These issues require focused attention in order to design and improve preventive strategies aiming to reduce the impact of specific cardiovascular risk factors for younger patients, such as diet, lifestyle, and weight control.
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19
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Luc JGY, Graham MM, Norris CM, Al Shouli S, Nijjar YS, Meyer SR. Predicting operative mortality in octogenarians for isolated coronary artery bypass grafting surgery: a retrospective study. BMC Cardiovasc Disord 2017; 17:275. [PMID: 29096604 PMCID: PMC5667481 DOI: 10.1186/s12872-017-0706-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 10/18/2017] [Indexed: 12/16/2022] Open
Abstract
Background Available cardiac surgery risk scores have not been validated in octogenarians. Our objective was to compare the predictive ability of the Society of Thoracic Surgeons (STS) score, EuroSCORE I, and EuroSCORE II in elderly patients undergoing isolated coronary artery bypass grafting surgery (CABG). Methods All patients who underwent isolated CABG (2002 – 2008) were identified from the Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease (APPROACH) registry. All patients aged 80 and older (n = 304) were then matched 1:2 with a randomly selected control group of patients under age 80 (n = 608 of 4732). Risk scores were calculated. Discriminatory accuracy of the risk models was assessed by plotting the areas under the receiver operator characteristic (AUC) and comparing the observed to predicted operative mortality. Results Octogenarians had a significantly higher predicted mortality by STS Score (3 ± 2% vs. 1 ± 1%; p < 0.001), additive EuroSCORE (8 ± 3% vs. 4 ± 3%; p < 0.001), logistic EuroSCORE (15 ± 14% vs. 5 ± 6%; p < 0.001), and EuroSCORE II (4 ± 3% vs. 2 ± 2%; p < 0.001) compared to patients under age 80 years. Observed mortality was 2% and 1% for patients age 80 and older and under age 80, respectively (p = 0.323). AUC revealed areas for STS, additive and logistic EuroSCORE I and EuroSCORE II, respectively, for patients age 80 and older (0.671, 0.709, 0.694, 0.794) and under age 80 (0.829, 0.750, 0.785, 0.845). Conclusion All risk prediction models assessed overestimated surgical risk, particularly in octogenarians. EuroSCORE II demonstrated better discriminatory accuracy in this population. Inclusion of new variables into these risk models, such as frailty, may allow for more accurate prediction of true operative risk.
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Affiliation(s)
- Jessica G Y Luc
- Division of Cardiac Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Michelle M Graham
- Mazankowski Alberta Heart Institute, Edmonton, Canada.,Division of Cardiology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Colleen M Norris
- Division of Cardiac Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.,Mazankowski Alberta Heart Institute, Edmonton, Canada.,Division of Cardiology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Sadek Al Shouli
- Division of Cardiac Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.,Mazankowski Alberta Heart Institute, Edmonton, Canada
| | - Yugmel S Nijjar
- Division of Cardiac Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Steven R Meyer
- Division of Cardiac Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada. .,Mazankowski Alberta Heart Institute, Edmonton, Canada.
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20
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Nicolini F, Vezzani A, Romano G, Carino D, Ricci M, Chicco MVD, Gherli T. Coronary Artery Bypass Grafting with Arterial Conduits in the Elderly. Int Heart J 2017; 58:647-653. [PMID: 28966319 DOI: 10.1536/ihj.16-468] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Although improved long-term outcomes obtained with the use of arterial grafts for coronary revascularization in comparison with the traditional association of a single arterial and saphenous vein grafts have been demonstrated in the overall population, the efficacy of this newer technique in the elderly is difficult to prove because their shorter life expectancy due to advanced heart disease, associated with severe comorbidities. Moreover, more widespread use of this technique is limited by the concerns on the potential morbidity, particularly the longer time required to perform the operation and the possibility of deep sternal wound infection in case of bilateral internal thoracic artery harvesting due to the decreased blood supply to the sternum and surrounding tissues.The review of the recent literature indicates that the use of bilateral internal thoracic arteries in very elderly patients should not be considered routinely. It seems reasonable to avoid it in octogenarians in the presence of well-known predictors of sternal complications such as diabetes, morbid obesity, and severe chronic lung disease.There is also still controversy about the superiority of the radial artery over the saphenous vein graft as a second or third conduit for surgical myocardial revascularization, although the majority of recent studies seem to support more liberal use of the radial artery as second arterial conduit in the elderly. Although a clinical benefit of arterial graft revascularization cannot be formally excluded for elderly patients, the increased complexity of this technique suggests that careful clinical judgment is necessary to select grafts for individual patients.
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Affiliation(s)
- Francesco Nicolini
- Cardiac Surgery Unit, Department of Clinical and Experimental Medicine, University of Parma
| | | | - Giorgio Romano
- Cardiac Surgery Unit, Department of Clinical and Experimental Medicine, University of Parma
| | - Davide Carino
- Cardiac Surgery Unit, Department of Clinical and Experimental Medicine, University of Parma
| | - Matteo Ricci
- Cardiac Surgery Unit, Department of Clinical and Experimental Medicine, University of Parma
| | | | - Tiziano Gherli
- Cardiac Surgery Unit, Department of Clinical and Experimental Medicine, University of Parma
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21
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Pemberthy-López C, Caraballo-Cordovez C, Gallo-Echeverri S, Jaramillo-Gómez N, Velásquez-Mejía C, Cardona-Vélez J, Contreras-Martínez H. Tratamiento del adulto mayor con síndrome coronario agudo. REVISTA COLOMBIANA DE CARDIOLOGÍA 2016. [DOI: 10.1016/j.rccar.2016.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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22
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Quick Evidence Synopsis. Cardiol Clin 2016. [DOI: 10.1016/j.ccl.2016.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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23
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Nicolini F, Vezzani A, Fortuna D, Contini GA, Pacini D, Gabbieri D, Zussa C, De Palma R, Gherli T. Gender differences in outcomes following isolated coronary artery bypass grafting: long-term results. J Cardiothorac Surg 2016; 11:144. [PMID: 27716382 PMCID: PMC5045636 DOI: 10.1186/s13019-016-0538-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 09/27/2016] [Indexed: 12/05/2022] Open
Abstract
Background The main purpose of this study was to evaluate the impact of gender on outcomes after isolated coronary artery bypass grafting, in terms of 5-year rates of overall death, cardiac-related death, myocardial infarction, re-hospitalization, repeat percutaneous or surgical revascularization, stroke, new pacemaker implantation, postoperative renal failure, heart failure and need for long-term care. Methods Two propensity-score matched cohorts, each of 1331 patients, undergoing isolated surgical coronary revascularization at the regional public and private centers of Emilia-Romagna region (Italy) from January 1st 2003 to December 31th 2013, were used to compare long-term outcomes of male (5976 patients) versus female gender (1332 patients). Results In the matched cohort, males received significantly more bypass grafts (3.0 ± 1.0 vs 2.8 ± 1.0, p = 0.001). Left internal mammary artery use and total arterial revascularization were similarly performed in both matched subgroups. Both groups reported similar cumulative rate of all-cause, cardiac-related mortality and stroke at five years. Females experienced significantly higher rate of myocardial infarction, and not significantly higher occurrence of heart failure, and need for long-term care. Males experienced significantly higher rate of cumulative re-hospitalization and higher need for pacemaker implantation. Female gender was not an independent predictor of death at long-term follow-up. Conclusions Women are more likely to be readmitted with myocardial infarction and congestive heart failure after CABG but experience survival similar to that observed in men. Female gender was not an independent risk factor for mortality. Prevention of new occurrence of postoperative myocardial infarction and enhancement of complete coronary revascularization should be future endpoints.
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Affiliation(s)
- Francesco Nicolini
- Clinical and Experimental Medicine Department, Cardiac Surgery Unit, University of Parma, Parma, Italy. .,Heart Surgery Unit - University of Parma, Via A. Gramsci 14, 43126, Parma, Italy.
| | - Antonella Vezzani
- Surgery Department, Cardiac Surgery Unit, Parma Hospital, Parma, Italy
| | | | | | - Davide Pacini
- Cardio-Thoracic-Vascular Department, University Hospital S.Orsola-Malpighi, Bologna, Italy
| | - Davide Gabbieri
- Department of Clinical Cardiology and Thoraco Vascular Surgery, Hesperia Hospital, Bologna, Italy
| | - Claudio Zussa
- Department of Cardiology and Cardiac Surgery, Villa Maria Cecilia Hospital, Bologna, Ravenna, Italy
| | | | - Tiziano Gherli
- Clinical and Experimental Medicine Department, Cardiac Surgery Unit, University of Parma, Parma, Italy
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Nicolini F, Fortuna D, Contini GA, Pacini D, Gabbieri D, De Palma R, Gherli T. Long-Term Outcomes of Conventional Aortic Valve Replacement in High-Risk Patients: Where Do We Stand? Ann Thorac Cardiovasc Surg 2016; 22:304-311. [PMID: 27645551 DOI: 10.5761/atcs.oa.16-00165] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
PURPOSE The introduction of transcatheter aortic valves has focused attention on the results of conventional aortic valve surgery in high-risk patients. The aim of the study was to evaluate 5-years outcomes in this category of patients in the current surgical era. METHODS This is an observational retrospective study of 581 high-risk patients undergoing aortic valve replacement from 2008 to 2013, with a mean logistic EuroSCORE of 26.6% ± 14.6%. Data were prospectively collected in a database of Emilia-Romagna region (Italy). RESULTS Overall 30-day mortality was 9.3%. Stroke rate was 1.5%. At 1-, 3-, and 5-years overall mortality was 18.2%, 30.4%, and 42.2%, cardiac death rate was 3.9%, 9.2%, and 12.9%, stroke rate 2.5%, 7.7%, and 10.2%, re-operation occurrence 0.2%, 0.9% and 1.3%, and new pacemaker implantation was 2.3%, 5.1% and 7.8%. At multivariate analysis, urgency, hemodynamic instability, LVEF ≤30%, NYHA III-IV, severe chronic obstructive pulmonary disease (COPD), extra-cardiac arteriopathy, cerebrovascular disease, and creatinine >2.0 mg/dL remained independent predictors of 5-year mortality. CONCLUSION The results of the current study add weight to the evidence that traditional aortic valve replacement can be performed in high-risk patients with satisfactory 5-year mortality and morbidity. Our study may help to improve decision-making in this category of high-risk patients with aortic valve disease.
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Affiliation(s)
- Francesco Nicolini
- Cardiac Surgery Unit, Clinical and Experimental Medicine Department, University of Parma, Parma, Italy
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Octogenarios: ¿demasiado ancianos para revascularización miocárdica quirúrgica? Respuesta. Rev Esp Cardiol (Engl Ed) 2016. [DOI: 10.1016/j.recesp.2016.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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26
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Octogenarios: ¿demasiado ancianos para revascularización miocárdica quirúrgica? Rev Esp Cardiol (Engl Ed) 2016. [DOI: 10.1016/j.recesp.2016.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Fernández-Rodríguez D, Grillo JJ, Martos-Maine JL, Bosa-Ojeda F. Octogenarians: Too Old for Surgical Myocardial Revascularization? ACTA ACUST UNITED AC 2016; 69:711-2. [PMID: 27236273 DOI: 10.1016/j.rec.2016.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 03/07/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Diego Fernández-Rodríguez
- Servicio de Cardiología, Hospital Universitario Nuestra Señora de Candelaria, Universidad de La Laguna, Santa Cruz de Tenerife, Spain.
| | - José J Grillo
- Servicio de Cardiología, Hospital Universitario Nuestra Señora de Candelaria, Universidad de La Laguna, Santa Cruz de Tenerife, Spain
| | - José L Martos-Maine
- Servicio de Cardiología, Hospital Universitario Nuestra Señora de Candelaria, Universidad de La Laguna, Santa Cruz de Tenerife, Spain
| | - Francisco Bosa-Ojeda
- Servicio de Cardiología, Hospital Universitario de Canarias, Universidad de La Laguna, San Cristóbal de La Laguna, Santa Cruz de Tenerife, Spain
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Sarnago Cebada F, Díez-Del Hoyo F, Rivera-Juárez A, Fernández-Avilés F. Octogenarians: Too Old for Surgical Myocardial Revascularization? Response. ACTA ACUST UNITED AC 2016; 69:712. [PMID: 27235288 DOI: 10.1016/j.rec.2016.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Accepted: 04/06/2016] [Indexed: 11/25/2022]
Affiliation(s)
| | - Felipe Díez-Del Hoyo
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Allan Rivera-Juárez
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Nicolini F, Fortuna D, Contini GA, Pacini D, Gabbieri D, Zussa C, De Palma R, Vezzani A, Gherli T. Comparison between off- and on-pump coronary artery bypass grafting: long-term results of a real-world registry. Eur J Cardiothorac Surg 2016; 50:528-35. [PMID: 27118313 DOI: 10.1093/ejcts/ezw128] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 02/08/2016] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The aim of this study was to compare 5-year rates of overall death, cardiac-related death, myocardial infarction, repeat revascularization, stroke and new occurrence of postoperative renal failure in a large cohort of patients with coronary disease, treated with on- or off-pump coronary artery bypass grafting (CABG). METHODS Two propensity score-matched cohorts, each of 560 patients, undergoing isolated surgical coronary revascularization at the regional public and private centres of Emilia-Romagna region (Italy) over the period 1 January 2003 - 31 December 2013, were used to compare long-term outcomes of on-pump CABG (6711 patients) and off-pump CABG (597 patients). RESULTS The matched on-pump group received significantly more bypass grafts than the matched off-pump group (2.4 ± 1.1 vs 1.6 ± 0.9, P < 0.0001). The on-pump group reported statistically significant lower cardiac-related mortality. There was a trend towards higher overall mortality and the need for repeat revascularization procedures in the off-pump group. No difference was found for myocardial infarction, stroke or new occurrence of postoperative renal failure between groups in the follow-up. The multivariate analysis of significant predictors of mortality in the overall population confirmed that the off-pump revascularization strategy was an independent predictor of death at long-term follow-up. On-pump CABG reported significantly better results in terms of mortality in the subgroups of patients with a depressed left ventricular ejection fraction and in patients with three-vessel disease. CONCLUSIONS In patients undergoing elective isolated CABG, on-pump strategy conferred a long-term survival advantage compared with off-pump strategy, particularly for patients with more extensive coronary disease. No benefits were found in terms of reduction of postoperative morbidity with the off-pump strategy. On-pump surgery should be the preferred revascularization technique, and off-pump surgery reserved for patients for whom the perioperative risk of cardiopulmonary bypass is greater than the risk of a less complete coronary revascularization.
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Affiliation(s)
- Francesco Nicolini
- Cardiac Surgery Unit, Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
| | - Daniela Fortuna
- Regional Agency for Health and Social Care, Emilia-Romagna Region, Bologna, Italy
| | | | - Davide Pacini
- Cardio-Thoracic-Vascular Department, University Hospital S.Orsola-Malpighi, Bologna, Italy
| | - Davide Gabbieri
- Department of Clinical Cardiology and Thoraco Vascular Surgery, Hesperia Hospital, Modena, Italy
| | - Claudio Zussa
- Department of Cardiology and Cardiac Surgery, Villa Maria Cecilia Hospital, Lugo (Ravenna), Spain
| | - Rossana De Palma
- Regional Agency for Health and Social Care, Emilia-Romagna Region, Bologna, Italy
| | - Antonella Vezzani
- Cardiac Surgery Unit, Surgery Department, Parma Hospital, Parma, Italy
| | - Tiziano Gherli
- Cardiac Surgery Unit, Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
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Yamaji K, Shiomi H, Morimoto T, Nakatsuma K, Toyota T, Ono K, Furukawa Y, Nakagawa Y, Kadota K, Ando K, Shirai S, Onodera T, Watanabe H, Natsuaki M, Sakata R, Hanyu M, Nishiwaki N, Komiya T, Kimura T. Effects of Age and Sex on Clinical Outcomes After Percutaneous Coronary Intervention Relative to Coronary Artery Bypass Grafting in Patients With Triple-Vessel Coronary Artery Disease. Circulation 2016; 133:1878-91. [PMID: 27009629 DOI: 10.1161/circulationaha.115.020955] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 03/18/2016] [Indexed: 11/16/2022]
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.
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Affiliation(s)
- Kyohei Yamaji
- 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.)
| | - Hiroki Shiomi
- 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.)
| | - Takeshi Morimoto
- 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.)
| | - Kenji Nakatsuma
- 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.)
| | - Toshiaki Toyota
- 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.)
| | - Koh Ono
- 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.)
| | - Yutaka Furukawa
- 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.)
| | - Yoshihisa Nakagawa
- 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.)
| | - Kazushige Kadota
- 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.)
| | - Kenji Ando
- 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.)
| | - Shinichi Shirai
- 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.)
| | - Tomoya Onodera
- 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.)
| | - Hirotoshi Watanabe
- 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.)
| | - Masahiro Natsuaki
- 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.)
| | - Ryuzo Sakata
- 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.)
| | - Michiya Hanyu
- 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.)
| | - Noboru Nishiwaki
- 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.)
| | - Tatsuhiko Komiya
- 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.)
| | - Takeshi Kimura
- 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.).
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Coronary artery bypass grafting in octogenarians: only when percutaneous coronary intervention is not feasible? Curr Opin Cardiol 2015; 30:636-42. [PMID: 26352246 DOI: 10.1097/hco.0000000000000222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The aim of this study was to review recent literature reporting the results of coronary revascularization by percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in patients older than 80 years. RECENT FINDINGS The review of recent studies on octogenarians demonstrates a surgical CABG advantage in the case of patients with increasing baseline coronary risk, such as severe multivessel disease, chronic total occlusions, and left ventricular dysfunction. PCI seems to be more appropriate for less severe degree and distribution of coronary lesions, and for subgroups of patients with higher surgical risk, such as acute coronary syndromes, reoperations, malignancy, dementia, poor mobility, frailty, and serious comorbidities contraindicating extracorporeal circulation. SUMMARY It is not the case that CABG is indicated only when there are contraindications to PCI. CABG confers more benefit than PCI in patients with increasing baseline cardiac risk, in the absence of serious systemic diseases that can reasonably reduce their life expectancy.CABG and PCI, with proper selection, should be considered complementary rather than competitive procedures in the therapy of octogenarians affected by coronary artery disease.
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Rankin JS. Invited commentary. Ann Thorac Surg 2015; 99:574-5. [PMID: 25639398 DOI: 10.1016/j.athoracsur.2014.10.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 10/23/2014] [Accepted: 10/31/2014] [Indexed: 11/25/2022]
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