ABSTRACT
BACKGROUND: Percutaneous Coronary Intervention (PCI) is emerging as new revascularization procedure for coronary artery disease patients. The octogenarians are the most fragile and vulnerable age group for any type of revascularization therapy and usually discarded from any randomized trials. There is no consensus in the choice of treatment among octogenarians including PCI and coronary artery bypass grafting (CABG). OBJECTIVE: To compare PCI and CABG among Thai octogenarians (> or = 80 years old) with coronary artery disease for immediate and 24-month clinical outcomes. MATERIAL AND METHOD: Retrospective cohort study was conducted at Siriraj Hospital from January 2005 to December 2007 to obtain a complete 24-month follow-up period after revascularization. From CALYSTO database, a list of all octogenarians was retrieved (n = 333); after cleaning of the data, 265 patients (PCIn = 202, CABG n = 63) were enrolled for the present study. The primary endpoint is defined as a 30-day major adverse cardiac and cerebral event (MACCE). Secondary endpoint is a 24-month major adverse event (MACE). RESULTS: The 30-day MACCE were 11.4% in PCI group vs. 44.4% in CABG group (p < 0.001), all cause-mortality was 2.5% in PCI group vs. 8.3% in CABG group (p = 0.05), cardiovascular mortality was 1% vs. 5% (p = 0.046), mortality from sepsis was 1.5% vs. 1.5% (p = 1.0). Recurrent MI was 5.4% vs. 4.8% (p = 0.74). Cerebrovascular event occurred in 0.5% vs. 1.6% (p = 0.10). There was a crossover treatment as 0.5% vs. 0% (p = 1.0). There was no repeat target revascularization at 30-day in both groups. Major vascular complication due to bleeding requiring > or = 5 of pack-red cell transfusion was more common in CABG group (1.5% vs. 31.8%, p < 0.001). At 24-month follow-up, MACE were 35.2% in PCI group vs. 27.9% in CABG group (p = 0.36), all cause-mortality was 11.3% vs. 27.9% (p = 0.002), cardiovascular mortality was 1.5% vs. 11.5% (p < 0.001). Sepsis mortality was 2.5% vs. 11.1% (p = 0.05). MI occurred in 7.4% vs. 6.3% (p = 1.0). Repeat target revascularization was higher in PCI group (20.3% vs. 0%, p < 0.001). However, hospital stay was longer in CABG group (4.7 +/- 9 vs. 16.8 +/- 17.4 days, p = 0.01). CONCLUSION: The current revascularization strategy was evaluated. These results reflect our physician selection, patient willingness to undergo the treatment option. Lesser 30-day and 24-month all-caused mortality, cardiovascular mortality, hospital stay was observed in PCI treated octogenarians with a trade off of more frequent repeat target revascularization.