Comparison by Meta-Analysis of Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Patients With a Mean Age of ≥70 Years

Alam, Mahboob; Virani, Salim S.; Shahzad, Saima A.; Siddiqui, Sahar; Siddiqui, Khaleeq H.; Mumtaz, Shahzad; Kleiman, Neal S.; Coselli, Joseph S.; Lakkis, Nasser; Jneid, Hani

doi:10.1016/j.amjcard.2013.04.034

Cited by 22 publications

(11 citation statements)

References 23 publications

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“…In meta-analyses of trials comparing PCI and CABG for coronary revascularization, CABG was found to have either similar7) or better12) mortality outcomes in elderly patients. Other recent meta-analyses of studies comparing PCI and CABG in patients with a mean age of ≥70 years and unprotected LMCA disease revealed no significant differences between PCI and CABG for all cause-mortality, nonfatal MI, and major adverse cardiac and cerebrovascular events (MACCE) at 30 days and 12 and 22 months; however, PCI was associated with shorter hospital stay and lower rates of early stroke but higher repeat revascularization rates on the longer term follow-up 13). However, in comparison to PCI, CABG surgery was associated with a higher risk of neurological complications, perioperative MI, renal failure, prolonged ventilation and nosocomial infections 14).…”

Section: Discussionmentioning

confidence: 96%

Unprotected Left Main Percutaneous Coronary Intervention in a 108-Year-Old Patient

Rahman

Islam

2014

Korean Circ J

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With the increase in life expectancy, the proportion of very elderly people is increasing. Coronary artery disease (CAD) is an important cause of mortality and morbidity in this age group, for which myocardial revascularization is often indicated. Percutaneous coronary intervention (PCI) in the very elderly bears the inherent risks of complications and mortality, but the potential benefits may outweigh these risks. A number of observational studies, registries, and few randomized controlled trials have shown the safety and feasibility of PCI in octogenarians and nonagenarians. However, PCI is only rarely done in centenarians; so, the outcome of percutaneous coronary revascularization in this age group is largely unknown. PCI in a centenarian with complex CAD is described here; the patient presented with unstable angina despite optimum medical therapy, and surgery was declined. Good angiographic success was followed by non-cardiac complications, which were managed with a multidisciplinary approach. (Korean Circ J 2014;44(2):113-117)

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Section: Discussionmentioning

confidence: 96%

Unprotected Left Main Percutaneous Coronary Intervention in a 108-Year-Old Patient

Rahman

Islam

2014

Korean Circ J

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“…53,54) Recent 2014 ESC/EACTS Guidelines on myocardial revascularization made no recommendations for the treatment of coronary artery disease in this subset of high risk patients. 55) Moreover, there are few data in the literature because meta-analyses have rarely been performed on the elderly population, 56) and clinical prospective randomized trials or multicenter studies did not generally study elderly patients, or included only a small proportion of these patients. [57][58][59] The evidence for the optimal revascularization procedure in octogenarians is thus reported mainly from observational studies, mostly singlecenter series comparing PCI and CABG with SITA grafting.…”

Section: Discussionmentioning

confidence: 99%

Coronary Artery Bypass Grafting with Arterial Conduits in the Elderly

Nicolini

Vezzani²,

Romano

et al. 2017

Int. Heart J.

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SummaryAlthough 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.(Int Heart J 2017; 58: 647-653) Key words: Coronary artery disease, Old patients, Arterial grafts N owadays a growing number of patients are older at the time of coronary artery bypass grafting (CABG) and present with a clinical history characterized by more comorbidities than in the past. However, despite the increasing proportions of elderly patients with a worse risk profile for elective CABG, mortality in elderly patients over recent decades has dramatically declined.1) In fact, recent studies on elderly patients operated with CABG reported a 30-day mortality rate ranging between 3.7 and 16.8%, a 1-year mortality between 8% and 10.8% and a 5-year mortality ranging from 28.4% to 31%. 2-6)It is well recognized that octogenarians have a higher risk of post-operative complications, 7) require greater clinical and economic resources, and have worse but acceptable short and long-term survival in comparison with younger patients. However, improvements in technical management, particularly the development of innovative extracorporeal circulatory systems, the use of off-pump CABG and the increased use of pedicled arterial conduits have been proven effective in improving outcomes, although they have not completely eliminated the morbidity in this high-risk population. [8][9][10][11][12][13][14] Although improved long-term outcomes obtained with the use of ...

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“…Поэтому у пациентов старшего возраста с показа-ниями к коронарному шунтированию и с повышен-ным риском повреждения мозга следует рассмотреть использование современных стентов, выделяющих лекарства, эффективность которых приближается к таковой при коронарном шунтировании [40][41][42].…”

Section: особенности диагностики и лечения ишемической болезни сердцаunclassified

The Specifics of Ischemic Heart Disease Management in Elderly

Белялов¹

2017

Russ J Cardiol

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Comparison by Meta-Analysis of Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Patients With a Mean Age of ≥70 Years

Cited by 22 publications

References 23 publications

Unprotected Left Main Percutaneous Coronary Intervention in a 108-Year-Old Patient

Unprotected Left Main Percutaneous Coronary Intervention in a 108-Year-Old Patient

Coronary Artery Bypass Grafting with Arterial Conduits in the Elderly

The Specifics of Ischemic Heart Disease Management in Elderly

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