Coronary angioplasty versus bypass surgery in patients &gt;70 years old matched for ventricular function

O’Keefe, James H.; Sutton, Matthew; McCallister, Ben D.; Vacek, James L.; Piehler, Jeffrey M.; Ligon, Robert W.; Hartzler, Geoffrey O.

doi:10.1016/0735-1097(94)90299-2

Cited by 44 publications

(14 citation statements)

References 23 publications

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“…Although the mechanism by which increasing age contributes to mortality is unknown, it has been postulated that the high mortality in the elderly compared with younger patients is precipitated by the presence of more comorbidities, more severe CAD, and reduced cardiac and overall physiologic reserve in these patients. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] Elderly patients have a higher incidence of diabetes mellitus and hypertension, whereas younger patients have a higher incidence of hyperlipidemia, family history of CAD, and current or former smoking. 16 The results of the present study are consistent with those from previous studies reporting more comorbidities in elderly patients.…”

Section: Discussionmentioning

confidence: 99%

“…Compared with the general population, elderly patients undergoing coronary revascularization have been more likely to present with more complex lesions, more unstable angina, and more comorbid conditions and a lower ejection fraction. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] However, the reasons for these adverse findings are not well understood, so the purpose of the present study was to assess the age-related differences in pre-percutaneous coronary intervention (PCI) intravascular ultrasound (IVUS) findings of target lesions treated with PCI in patients with CAD.…”

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confidence: 99%

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Age-Related Differences in Intravascular Ultrasound Findings in 1,009 Coronary Artery Disease Patients

Hong

Jeong

Sim

et al. 2008

Circ J

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Background The aim of this study was to assess the age-related differences in intravascular ultrasound (IVUS) findings of target lesions in patients with coronary artery disease. (n=93)]. Calcified plaque (18%, 25%, 33%, 38%, and 46%, p<0.001) and negative remodeling (29%, 48%, 44%, 44%, and 66%, p<0.001) were most common, and reference segment plaque burden (35±11%, 35±10%, 39±10%, 38±10%, and 40±11%, p<0.001) was greatest in Group V. Plaque rupture (52%, 31%, 42%, 38%, and 20%, p=0.009) and thrombus (38%, 30%, 31%, 24%, and 11%, p=0.026) were most common in Group I. In the multiple logistic regression analysis, patient age was an independent predictor of calcified plaque (odds ratio (OR)=1.03, p=0.001), negative remodeling (OR= 1.04, p=0.001), and mean reference segment plaque burden >50% (OR=1.03, p=0.006). Conclusion Elderly patients have more severe calcifications with negative remodeling and diffuse atherosclerosis, whereas younger patients have more unstable plaque morphology. (Circ J 2008; 72: 1270 -1275 Methods and Results

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Age-Related Differences in Intravascular Ultrasound Findings in 1,009 Coronary Artery Disease Patients

Hong

Jeong

Sim

et al. 2008

Circ J

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“…Older adults derive benefit from many other cardiovascular preventive and therapeutic interventions, including antihypertensive therapies (8), coronary artery bypass grafting (9), and percutaneous coronary intervention (10). For statins, post hoc analyses of randomized controlled trials have demonstrated effective reductions of CHD mortality (11)(12)(13), all-cause mortality (11,13), and composite cardiovascular events in elderly persons (11,13).…”

mentioning

confidence: 99%

Efficacy and Safety of Statin Monotherapy in Older Adults: A Meta-Analysis

Güallar

Rodríguez³

2007

The Journals of Gerontology Series A: Biological Sciences and M

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Background. Statin therapy significantly reduces cardiovascular events. Older patients, however, are less likely to be prescribed statins than younger patients due to concern over lack of indication, lower predictive value of cholesterol levels, and increased risk of adverse events. To determine the effect of statins on all-cause mortality and on major cardiovascular events, including stroke, we performed a meta-analysis of statin trials that included older adult participants.

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“…The current study suggests that diabetic patients with discrete disease that can be completely revascularized with angioplasty can be candidates for angioplasty if other clinical factors are favourable. In other studies including diabetic and non-diabetic patients, the ability to achieve complete revascularization with angioplasty [22,23] has been associated with long-term outcomes as good or better after angioplasty compared with bypass surgery. Current cigarette smokers [24] females [3] and patients with impaired renal function [25] are subgroups that have all been shown previously to have suboptimal outcomes after elective angioplasty in general populations.…”

Section: Coronary Revascularization For Diabetics 1699mentioning

confidence: 99%

The optimal mode of coronary revascularization for diabetics A risk-adjusted long-term study comparing coronary angioplasty and coronary bypass surgery

O’Keefe

Blackstone

Sergeant

et al. 1998

European Heart Journal

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Aims Some recent studies have reported superior outcomes for diabetic patients following coronary bypass surgery compared with coronary angioplasty. However, the available data are conflicting, are based on relatively small numbers of diabetic patients, and have limited duration of follow-up. The aims of this study were to compare risk adjusted long-term survival in diabetic patients following first-time revascularization via either coronary bypass surgery or coronary angioplasty; and, to identify variables independently associated with mortality. Methods and ResultsThis was a two centre database project involving 15 809 patients undergoing either coronary angioplasty or coronary bypass surgery as their initial revascularization procedure. Diabetes was present in 1938 (12%). Mean follow-up was 4·6 2·7 years for angioplasty and 6·6 4·3 years surgery diabetic patients. Multivariable time-related analyses in the hazard function domain for death were performed.Overall ten-year survival for pharmacologically treated diabetics was better after coronary bypass surgery (60%) than angioplasty (46%, <0·0001). However, the riskadjusted survival advantage conferred by bypass surgery over angioplasty was strongest for patients receiving oral agents for diabetic control (75% vs 62%) and less impressive for diet (84% vs 81%) and insulin-treated diabetics (63% vs 64%). The major factors independently associated with worse outcome after angioplasty were incomplete revascularization, and the use of a sulfonylurea agent. The use of the left internal mammary graft improved survival in surgical patients. ConclusionsIn general, diabetic patients had better longterm survival after bypass surgery than angioplasty. Incomplete revascularization and sulfonylurea therapy worsened outcome after angioplasty, and use of the left internal mammary improved outcome after bypass surgery.

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Coronary angioplasty versus bypass surgery in patients >70 years old matched for ventricular function

Abstract: When performed in patients > 70 years old, angioplasty and coronary bypass surgery result in similar long-term survival rates but otherwise distinctly different clinical courses.

Cited by 44 publications

References 23 publications

Age-Related Differences in Intravascular Ultrasound Findings in 1,009 Coronary Artery Disease Patients

Age-Related Differences in Intravascular Ultrasound Findings in 1,009 Coronary Artery Disease Patients

Efficacy and Safety of Statin Monotherapy in Older Adults: A Meta-Analysis

The optimal mode of coronary revascularization for diabetics A risk-adjusted long-term study comparing coronary angioplasty and coronary bypass surgery

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