Survival after coronary revascularization in the elderly

Background-Elderly patients with ischemic heart disease are increasingly referred for coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). However, reports of poor outcomes in the elderly have led to questions about the benefit of these strategies. We studied survival by prescribed treatment (CABG, PCI, or medical therapy) for patients in 3 age categories <70 years, 70 to 79 years, and greater than or equal to80 years of age. Methods and Results-The Alberta Provincial Project for Outcomes Assessment in Coronar Heart Disease (APPROACH) is a clinical data collection and outcome monitoring initialtive capturing all patients Undergoing cardiac catheterization and revascularization in the province of Alberta. Canada. since 1995, Characteristics and long-term outcomes of a cohort of >6000 elderly patients with ischemic heart disease were compared with younger patients. In 15 392 patients >70 wars of age. 4-year adjusted actuarial survival rates for CABG. PCL and medical therapy were 95.0%, 93.8% and 90.5% respectivly. In 5198 patients 70 to 79 years of age survival rates were 87.3%, 83.9% and 79.1% respectively. In 983 patients greater than or equal to80 years of age, survival was 77.4% for CABG, 71.6% for PCI, and 60.3% for medical therapy. Absolute risk differences in comparison to medical therapy for CABG (17.0%) and PCI (11.3%) were greater for patients greater than or equal to80 years of age than for younger Patients. Conclusions-Elderly patient,, paradoxically have greater absolute risk reductions Associated with surgical Or percutaneous revascularization than do younger patient,.,, The combination of these results with a recent randomized trial suggests that the benefits of aggressive revascularization therapies may extend to subset, Of patients in older age groups.