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European Heart Journal Advance Access originally published online on September 27, 2007
European Heart Journal 2007 28(22):2714-2719; doi:10.1093/eurheartj/ehm403
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2007. For permissions please email: journals.permissions@oxfordjournals.org

A comparison between coronary artery bypass grafting surgery and drug eluting stent for the treatment of unprotected left main coronary artery disease in elderly patients (aged ≥75 years)

Tullio Palmerini1,*, Fabio Barlocco2, Andrea Santarelli3, Letizia Bacchi-Reggiani1, Carlo Savini4, Elisa Baldini2, Laura Alessi1, Michele Ruffini3, Germano Di Credico5, Giancarlo Piovaccari3, Roberto Di Bartolomeo4, Antonio Marzocchi1, Angelo Branzi1 and Stefano De Servi2

1 Istituto di Cardiologia, Università di Bologna, Policlinico S. Orsola, Via Massarenti 9, 40 138 Bologna, Italy
2 Dipartimento di Cardiologia, Legnano, Italy
3 Dipartimento di Cardiologia, Rimini, Italy
4 Istituto di Cardiochirurgia, Policlinico S. Orsola, Bologna, Italy
5 Dipartimento Cardiochirurgia, Legnano

Received 5 June 2007; revised 14 August 2007; accepted 23 August 2007; online publish-ahead-of-print 27 September 2007.

* Corresponding author. Tel: +39 051 349858; fax: +39 051 344859. E-mail address: tulliopalmerini{at}hotmail.com

Aims: In this study, we compared the clinical outcomes of elderly patients with unprotected left main coronary artery (ULMCA) stenosis treated with either coronary artery bypass grafting (CABG) or drug-eluting stent (DES).

Methods and results: From January 2003 to April 2006, 259 patients with ULMCA stenosis and age ≥75 years underwent coronary revascularization with either CABG or DES. One hundred and sixty-one patients were treated with CABG and 98 with DES. The cumulative unadjusted rates of 2-year mortality were 17% in CABG-treated patients and 18% in those treated with DES (P = 0.71). The adjusted rates of 2-year survival were 85% for CABG-treated patients and 87% for DES-treated patients (P = 0.74). The incidence of 2-year myocardial infarction was 6% in CABG-treated patients and 4% in DES-treated patients (P = 0.11). The incidence of target lesion revascularization (TLR) was 3% in CABG-treated patients and 25% in DES-treated patients (P < 0.0001). In the multivariable analysis, peripheral vascular disease, left ventricular ejection fraction and acute coronary syndrome were independent predictors of 2-year mortality.

Conclusion: In this study, we could not demonstrate a difference in mortality between CABG-treated patients and those treated with DES. However, the rate of TLR was higher in the DES group.

Key Words: Stents • Bypass • Coronary disease


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