• Marcus Flather, June-Wha Rhee, Derek B Boothroyd, Eric Boersma, Maria Mori Brooks, Didier Carrié, Tim C Clayton, Nicholas Danchin, Christian W Hamm, Whady A Hueb, Spencer B King, Stuart J Pocock, Alfredo E Rodriguez, Patrick Serruys, Ulrich Sigwart, Rodney H Stables, and Mark A Hlatky.
• University of East Anglia, Norwich, United Kingdom.
• J. Am. Coll. Cardiol. 2012 Nov 20; 60 (21): 2150-7.

ObjectivesThis study sought to assess whether patient age modifies the comparative effectiveness of coronary artery bypass graft (CABG) surgery and percutaneous coronary intervention (PCI).BackgroundIncreasingly, CABG and PCI are performed in older patients to treat multivessel disease, but their comparative effectiveness is uncertain.MethodsIndividual data from 7,812 patients randomized in 1 of 10 clinical trials of CABG or PCI were pooled. Age was analyzed as a continuous variable in the primary analysis and was divided into tertiles for descriptive purposes (≤56.2 years, 56.3 to 65.1 years, ≥65.2 years). The outcomes assessed were death, myocardial infarction and repeat revascularization over complete follow-up, and angina at 1 year.ResultsOlder patients were more likely to have hypertension, diabetes, and 3-vessel disease compared with younger patients (p < 0.001 for trend). Over a median follow-up of 5.9 years, the effect of CABG versus PCI on mortality varied according to age (interaction p < 0.01), with adjusted CABG-to-PCI hazard ratios and 95% confidence intervals (CI) of 1.23 (95% CI: 0.95 to 1.59) in the youngest tertile; 0.89 (95% CI: 0.73 to 1.10) in the middle tertile; and 0.79 (95% CI: 0.67 to 0.94) in the oldest tertile. The CABG-to-PCI hazard ratio of less than 1 for patients 59 years of age and older. A similar interaction of age with treatment was present for the composite outcome of death or myocardial infarction. In contrast, patient age did not alter the comparative effectiveness of CABG and PCI on the outcomes of repeat revascularization or angina.ConclusionsPatient age modifies the comparative effectiveness of CABG and PCI on hard cardiac events, with CABG favored at older ages and PCI favored at younger ages.Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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