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Effect of increasing age on percutaneous coronary intervention vs coronary artery bypass grafting in older adults with unprotected left main coronary artery disease: A meta‐analysis and meta‐regression

BACKGROUND: Older adults (≥70‐year‐old) are under‐represented in the published data pertaining to unprotected left main coronary artery disease (ULMCAD). Hypothesis: Percutaneous coronary intervention (PCI) might be comparable to coronary artery bypass grafting (CABG) for revascularization of ULMCAD...

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Autores principales: Khan, Mahin R., Kayani, Waleed T., Ahmad, Waqas, Manan, Malalai, Hira, Ravi S., Hamzeh, Ihab, Jneid, Hani, Virani, Salim S., Kleiman, Neal, Lakkis, Nasser, Alam, Mahboob
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wiley Periodicals, Inc. 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6837018/
https://www.ncbi.nlm.nih.gov/pubmed/31486094
http://dx.doi.org/10.1002/clc.23253
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author Khan, Mahin R.
Kayani, Waleed T.
Ahmad, Waqas
Manan, Malalai
Hira, Ravi S.
Hamzeh, Ihab
Jneid, Hani
Virani, Salim S.
Kleiman, Neal
Lakkis, Nasser
Alam, Mahboob
author_facet Khan, Mahin R.
Kayani, Waleed T.
Ahmad, Waqas
Manan, Malalai
Hira, Ravi S.
Hamzeh, Ihab
Jneid, Hani
Virani, Salim S.
Kleiman, Neal
Lakkis, Nasser
Alam, Mahboob
author_sort Khan, Mahin R.
collection PubMed
description BACKGROUND: Older adults (≥70‐year‐old) are under‐represented in the published data pertaining to unprotected left main coronary artery disease (ULMCAD). Hypothesis: Percutaneous coronary intervention (PCI) might be comparable to coronary artery bypass grafting (CABG) for revascularization of ULMCAD. METHODS: We compared PCI versus CABG in older adults with ULMCAD with an aggregate data meta‐analyses (4880 patients) of clinical outcomes [all‐cause mortality, myocardial infarction (MI), repeat revascularization, stroke and major adverse cardiac and cerebrovascular events(MACCE)] at 30 days, 12‐24 months & ≥36 months in patients with mean age ≥70 years and ULMCAD. A meta‐regression analysis evaluated the effect of age on mortality after PCI. Odds ratios (OR) and 95% confidence intervals (CI) were estimated using random‐effects model. RESULTS: All‐cause mortality between PCI and CABG was comparable at 30‐days (OR0.77, 95% CI 0.42‐ 1.41) and 12‐24‐months (OR 1.22, 95% CI 0.78‐1.93). PCI was associated with a markedly lower rate of stroke at 30‐day follow‐up in octogenarians (OR 0.14, 95% CI 0.02‐0.76) but an overall higher rate of repeat revascularization. At ≥36‐months, MACCE (OR 1.26,95% CI 0.99‐1.60) and all‐cause mortality (OR 1.39, 95% CI 1.00‐1.93) showed a trend favoring CABG but did not reach statistical significance. On meta‐regression, PCI was associated with a higher mortality with advancing age (coefficient=0.1033, p=0.042). CONCLUSIONS: PCI was associated with a markedly lower rate of early stroke in octogenarians as compared to CABG. All‐cause mortality was comparable between the two arms with a trend favoring CABG at ≥36‐months.PCI was however associated with increasing mortality with advancing age as compared to CABG.
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spelling pubmed-68370182019-11-12 Effect of increasing age on percutaneous coronary intervention vs coronary artery bypass grafting in older adults with unprotected left main coronary artery disease: A meta‐analysis and meta‐regression Khan, Mahin R. Kayani, Waleed T. Ahmad, Waqas Manan, Malalai Hira, Ravi S. Hamzeh, Ihab Jneid, Hani Virani, Salim S. Kleiman, Neal Lakkis, Nasser Alam, Mahboob Clin Cardiol Reviews BACKGROUND: Older adults (≥70‐year‐old) are under‐represented in the published data pertaining to unprotected left main coronary artery disease (ULMCAD). Hypothesis: Percutaneous coronary intervention (PCI) might be comparable to coronary artery bypass grafting (CABG) for revascularization of ULMCAD. METHODS: We compared PCI versus CABG in older adults with ULMCAD with an aggregate data meta‐analyses (4880 patients) of clinical outcomes [all‐cause mortality, myocardial infarction (MI), repeat revascularization, stroke and major adverse cardiac and cerebrovascular events(MACCE)] at 30 days, 12‐24 months & ≥36 months in patients with mean age ≥70 years and ULMCAD. A meta‐regression analysis evaluated the effect of age on mortality after PCI. Odds ratios (OR) and 95% confidence intervals (CI) were estimated using random‐effects model. RESULTS: All‐cause mortality between PCI and CABG was comparable at 30‐days (OR0.77, 95% CI 0.42‐ 1.41) and 12‐24‐months (OR 1.22, 95% CI 0.78‐1.93). PCI was associated with a markedly lower rate of stroke at 30‐day follow‐up in octogenarians (OR 0.14, 95% CI 0.02‐0.76) but an overall higher rate of repeat revascularization. At ≥36‐months, MACCE (OR 1.26,95% CI 0.99‐1.60) and all‐cause mortality (OR 1.39, 95% CI 1.00‐1.93) showed a trend favoring CABG but did not reach statistical significance. On meta‐regression, PCI was associated with a higher mortality with advancing age (coefficient=0.1033, p=0.042). CONCLUSIONS: PCI was associated with a markedly lower rate of early stroke in octogenarians as compared to CABG. All‐cause mortality was comparable between the two arms with a trend favoring CABG at ≥36‐months.PCI was however associated with increasing mortality with advancing age as compared to CABG. Wiley Periodicals, Inc. 2019-09-05 /pmc/articles/PMC6837018/ /pubmed/31486094 http://dx.doi.org/10.1002/clc.23253 Text en © 2019 The Authors. Clinical Cardiology published by Wiley Periodicals, Inc. This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Reviews
Khan, Mahin R.
Kayani, Waleed T.
Ahmad, Waqas
Manan, Malalai
Hira, Ravi S.
Hamzeh, Ihab
Jneid, Hani
Virani, Salim S.
Kleiman, Neal
Lakkis, Nasser
Alam, Mahboob
Effect of increasing age on percutaneous coronary intervention vs coronary artery bypass grafting in older adults with unprotected left main coronary artery disease: A meta‐analysis and meta‐regression
title Effect of increasing age on percutaneous coronary intervention vs coronary artery bypass grafting in older adults with unprotected left main coronary artery disease: A meta‐analysis and meta‐regression
title_full Effect of increasing age on percutaneous coronary intervention vs coronary artery bypass grafting in older adults with unprotected left main coronary artery disease: A meta‐analysis and meta‐regression
title_fullStr Effect of increasing age on percutaneous coronary intervention vs coronary artery bypass grafting in older adults with unprotected left main coronary artery disease: A meta‐analysis and meta‐regression
title_full_unstemmed Effect of increasing age on percutaneous coronary intervention vs coronary artery bypass grafting in older adults with unprotected left main coronary artery disease: A meta‐analysis and meta‐regression
title_short Effect of increasing age on percutaneous coronary intervention vs coronary artery bypass grafting in older adults with unprotected left main coronary artery disease: A meta‐analysis and meta‐regression
title_sort effect of increasing age on percutaneous coronary intervention vs coronary artery bypass grafting in older adults with unprotected left main coronary artery disease: a meta‐analysis and meta‐regression
topic Reviews
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6837018/
https://www.ncbi.nlm.nih.gov/pubmed/31486094
http://dx.doi.org/10.1002/clc.23253
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