ANGIOPLASTY VERSUS CORONARY-ARTERY BYPASS IN OCTOGENARIANS

We retrospectively analyzed early and late results for two treatment s trategies of significant coronary artery disease in 310 octogenarians seen in the last 10 years. One hundred five patients 80 or more years of age had percutaneous transluminal coronary angioplasty (PTCA) and 2 05 had coronary artery bypass grafting (CABG). The PTCA group differed from the CABG group in having a greater proportion of women (71.4% ve rsus 45.8%; p < 0.001); fewer patients with unstable angina (24.7% ver sus 33.6%; p < 0.04), acute myocardial infarction (11% versus 23%; p < 0.04), three-vessel coronary artery disease (20% versus 56%; p < 0.00 01), and a left ventricular ejection fraction less than or equal to 0. 30 (10% versus 21%; p < 0.008); and fewer vessels revascularized (1.2 +/- 0.6 versus 3.5 +/- 0.9; p < 0.0001). Hospital mortality was 8.57% after PTCA (9/14 failed PTCA) and 5.8% after CABG (4/14 emergent, 6/10 1 urgent, and 2/90 elective). Hospital stay was 7 +/- 0.9 days after P TCA and 14 +/- 1.5 days rafter CABG (p < 0.01). Independent predictors of hospital mortality obtained by multivariate analysis included fail ed PTCA and acute myocardial infarction (PTCA group), a left ventricul ar ejection fraction equal to or less than 0.30, and acute myocardial infarction and emergency CABG (CABG group). Survivors after both CABG and PTCA showed a significant improvement in their New York Heart Asso ciation class. Actuarial survival at 5 years after PTCA was 55% and af ter CABG it was 66% (p < 0.01). Cardiac event-free survival (deaths, m yocardial infarction, PTCA, CABG) at 3 years was 61% after PTCA and 81 % after CABG (p < 0.01). In octogenarians, PTCA had a greater mortalit y and failure rate than in our younger patients. Overall morbidity was higher after CABG than after PTCA (p < 0.05), given the nature and th e severity of the increased risk factors in the CABG group.