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Comparative Study
. 2021 Dec;69(12):3457-3467.
doi: 10.1111/jgs.17404. Epub 2021 Aug 7.

Revascularization versus medical therapy in patients aged 80 and older with stable ischemic heart disease

Derek Q Phan  1 , Ray Zadegan  1 , Ming-Sum Lee  2
Affiliations
Comparative Study

Revascularization versus medical therapy in patients aged 80 and older with stable ischemic heart disease

Derek Q Phan et al. J Am Geriatr Soc. 2021 Dec.

Abstract

Background: Older patients are underrepresented in landmark randomized trials for stable ischemic heart disease (SIHD). Therefore, we sought to evaluate the benefits of revascularization in patients ≥80 years old with SIHD.

Methods: Retrospective study of patients undergoing invasive coronary angiography (ICA) for SIHD between 2009 and 2019. Patients were grouped according to treatment: revascularization (percutaneous coronary intervention [PCI] or coronary artery bypass grafting [CABG]) versus initial medical therapy alone. Inverse probability of treatment weighting (IPTW)-adjusted Cox proportional hazard regression analyses were performed. Outcomes evaluated were all-cause mortality, non-fatal myocardial infarction (MI), and repeat revascularization.

Results: A total of 1015 patients (median age 83.0, interquartile range [IQR] 81.3-85.2 years; 29% female) underwent ICA for SIHD. Of these, 557 (55%) were treated with revascularization and 458 (45%) with initial medical therapy alone. Baseline characteristics were well balanced after IPTW adjustment. At median follow-up of 3.5 years (IQR 1.7-5.9 years), there were no differences in all-cause mortality and non-fatal MI between treatment groups; but there was an increased need for repeat revascularization (IPTW adjusted hazard ratio 2.22, 95% confidence interval 1.53-3.22) with revascularization. Separately comparing PCI or CABG alone versus medical therapy yielded similar results; as well as in subgroup analysis (except for patients ≥90 years old and those without prior CABG).

Conclusion: There were no differences in all-cause mortality and non-fatal MI with invasive revascularization (either PCI or CABG) versus medical therapy alone in patients ≥80 years old with SIHD. Large randomized trials focusing on older patients are warranted to guide clinical practice in this growing population.

Keywords: coronary artery bypass grafting; medical therapy; older adults; percutaneous coronary intervention; stable ischemic heart disease.

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References

REFERENCES

    1. Benjamin EJ, Muntner P, Alonso A, et al. Heart Disease and Stroke Statistics - 2019 update: a report from the American Heart Association. Circulation. 2019;139(10):e56-e528. https://doi.org/10.1161/CIR.0000000000000659 Erratum in: Circulation. 2020 Jan 14;141(2):e33. PMID: 30700139.
    1. Madhavan MV, Gersh BJ, Alexander KP, Granger CB, Stone GW. Coronary artery disease in patients ≥80 years of age. J Am Coll Cardiol. 2018;71(18):2015-2040. https://doi.org/10.1016/j.jacc.2017.12.068
    1. Rich MW, Chyun DA, Skolnick AH, et al. Knowledge gaps in cardiovascular care of the older adult population: a scientific statement from the American Heart Association, American College of Cardiology, and American Geriatrics Society. J Am Coll Cardiol. 2016;67(20):2419-2440. https://doi.org/10.1016/j.jacc.2016.03.004
    1. Tahhan AS, Vaduganathan M, Greene SJ, et al. Enrollment of older patients, women, and racial/ethnic minority groups in contemporary acute coronary syndrome clinical trials: a systematic review. JAMA Cardiol. 2020;5(6):714-722. https://doi.org/10.1001/jamacardio.2020.0359
    1. Phan DQ, Duan L, Lam B, et al. Statin adherence and mortality in patients aged 80 years and older after acute myocardial infarction. J Am Geriatr Soc. 2019;67(10):2045-2049. https://doi.org/10.1111/jgs.16037

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