Skip to main content
  • 600 Accesses

Abstract

How to deal with an aging population whilst facing increasing health care costs and decreasing resources for an optimal health care management, will be the decisive question in the upcoming years. Prospective trials and registries have shown comparable survival rates and increased quality of life, for patients treated with intervention or surgery. Subsequently, overall invasive procedures, either PCI or CABG-procedure, show advantages over medical therapy. Among older adults both options increasingly provide better results regarding short term mortality and especially longterm mortality. Which of these alternatives will be the most appropriate one for an individual patient, remains the most challenging question in this context.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 159.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. US Census Bureau “2008 National Population Projections” released August 2008; www.census.gov/population/www/projections/2008projections.html.

  2. National center for health statistics. National health interview survey 1983–1985. Hyattsville: The Center; 1986.

    Google Scholar 

  3. Gurwitz JH, Col NF, Avorn J. The exclusion of the elderly and women from clinical trials in acute myocardial infarction. JAMA. 1992;268:1417–22.

    Article  CAS  PubMed  Google Scholar 

  4. Lee PY, Alexander KP, Hammill BG, Pasquali SK, Peterson ED. Representation of elderly persons and women in published randomized trials of acute coronary syndromes. JAMA. 2001;286:708–13.

    Article  CAS  PubMed  Google Scholar 

  5. Windecker S, for the TASK Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association of Percutaneous Cardiovascular Interventions (EAPCI). 2014 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J. 2014;35:2541–619.

    Article  PubMed  Google Scholar 

  6. Rittger H, Rieber J, Breithardt OA, Dücker M, Schmidt M, Abbara S, Sinha AM, Jakob A, Nölker G, Brachmann J. Influence of age on pain perception in acute myocardial ischemia: a possible cause for delayed treatment in older patients. Int J Cardiol. 2011;149:63–7.

    Article  CAS  PubMed  Google Scholar 

  7. Ambepitiyja G, Roberts M, Ranjadayalan K, Tallis R. Silent exertional myocardial ischemia in the elderly. A quantitative analysis of angina perceptual threshold and the influence of autonomic function. J Am Geriatr Soc. 1994;42:732–7.

    Article  Google Scholar 

  8. Ellestadt MH, Kaun P. Naloxone and asymptomatic ischemia: failure to induce angina during exercise testing. Am J Cardiol. 1984;54:982–4.

    Article  Google Scholar 

  9. Hatfield BD, Goldfarb AH, Sforzo GA, Flynn MG. Serum beta-endorphin and affective response to graded exercise in young and elderly men. J Gerontol. 1987;42:429–31.

    Article  CAS  PubMed  Google Scholar 

  10. Morley JE. Neuropeptides: behaviour and aging. J Am Geriatr Soc. 1986;34:52–61.

    Article  CAS  PubMed  Google Scholar 

  11. Chaitman BR, Rosen AD, Williams DO, et al. Myocardial infarction and cardiac mortality in the Bypass angioplasty revascularization investigation (BARI) randomized trial. Circulation. 1997;96:2162–70.

    Article  CAS  PubMed  Google Scholar 

  12. Graham MM, Ghali A, Faris P, et al. Survival after coronary revascularization in the elderly. Circulation. 2002;105:2378–84.

    Article  PubMed  Google Scholar 

  13. Rittger H, Rieber J, Kögler K, Sinha AM, Schmidt M, Breithardt OA, Biggar P, Einsle F, Diegeler A, Brachmann J. Clinical outcome and quality of life after interventional treatment of left main disease with drug-eluting stents in comparison to CABG in elderly and younger patients. Clin Res Cardiol. 2011;100:439–46.

    Article  CAS  PubMed  Google Scholar 

  14. Serrruys PW, Ong ATL, Herwerden LA, et al. Five-year outcomes after coronary stenting versus bypass surgery for the treatment of multivessel disease – the final analysis of the arterial revascularization therapy study (ARTS) randomized trial. J Am Coll Cardiol. 2005;46:575–81.

    Article  Google Scholar 

  15. Rodriguez AR, Baldi J, Pereira CF, Navia J, Alemparte MR, Delacasa A, Vigo F, Vogel D, O’Neill W, Palacios I. Five-year follow-up of the argentine randomized trial of coronary angioplasty with stenting versus coronary bypass surgery in patients with multiple vessel disease (ERACI II). J Am Coll Cardiol. 2005;46:582–8.

    Article  PubMed  Google Scholar 

  16. Zhang Z, Mahoney EM, Spertus JA, et al. The impact of age on outcomes after coronary artery bypass surgery versus stent-assisted percutaneous coronary intervention: one-year results from the Stent or Surgery (SoS) trial. Am Heart J. 2006;152:1153–60.

    Article  PubMed  Google Scholar 

  17. Morrison DA, Sethi G, Sacks J, et al. Percutaneous coronary intervention versus coronary artery bypass graft surgery for patients with medically refractory myocardial ischemia and risk factors for adverse outcomes with bypass: a multicenter, randomized trial. Investigators of the Department of Veterans Affairs Cooperative Study Number 385, the Angina with Extremely Serious Operative Mortality Evaluation (AWESOME). J Am Coll Cardiol. 2001;38:143–9.

    Article  CAS  PubMed  Google Scholar 

  18. Kappetein AP, Feldmann TE, Mack MJ, Morice MC, Holmes DR, Stahle E, Dawkins KD, Mohr FW, Serruys PW, Colombo A. Comparison of coronary bypass surgery with drug-eluting stenting for the treatment of left main and/or three-vessel disease: three year follow up of the SYNTAX trial. Eur Heart J. 2011;32:2125–34.

    Article  PubMed  Google Scholar 

  19. Kurlansky PA, Williams DB, Traad EA, Zucker M, Ebra G. Eighteen-year follow-up demonstrates prolonged survival and enhanced quality of life for octogenarians after coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2011;141:394–9.

    Article  PubMed  Google Scholar 

  20. Edmunds LH, Stephenson LW, Edie RN, Ratcliffe MB. Open-heart surgery in octogenarians. N Engl J Med. 1988;318:131–6.

    Article  Google Scholar 

  21. Mc Kellar SH, Brown ML, Frye RL, Schaff HV, Sundt III TM. Comparison of coronary revascularization procedures in octogenarians: a systematic review and meta-analysis. Nat Clin Pract Cardiovasc Med. 2008;5:738–46.

    Article  Google Scholar 

  22. Saxena A, Dinh DT, Yap CH, et al. Critical analysis of early and late outcomes after isolated coronary artery bypass surgery in elderly patients. Ann Thorac Surg. 2011;92:1702–11.

    Article  Google Scholar 

  23. Li Z, Amsterdam EA, Yeo KK, et al. Coronary artery bypass operations for elderly patients in California, 2003 to 2008. Ann Thorac Surg. 2012;93:1167–73.

    Article  PubMed  Google Scholar 

  24. Sheridan BC, Stearns SC, Rossi JS, D’Arcy LP, Federspiel JJ, Carey TS. Three-year outcomes of multivessel revascularization in very elderly acute coronary syndrome patients. Ann Thorac Surg. 2010;89:1889–95.

    Article  PubMed Central  PubMed  Google Scholar 

  25. Alexander KP, Anstrom KJ, Mühlbaier LH, et al. Outcomes of cardiac surgery in patients age >80 ys: results from the National Cardiovascular Network. J Am Coll Cardiol. 2000;35:731–8.

    Article  CAS  PubMed  Google Scholar 

  26. Afilalo J, Eisenberg MJ, Morin JF, et al. Gait speed as an incremental predictor of mortality and major morbidity in elderly patients undergoing cardiac surgery. J Am Coll Cardiol. 2010;56:1668–76.

    Article  PubMed  Google Scholar 

  27. Afilalo J, Mottillo B, Eisenberg MJ, et al. Addition of frailty and disability to cardiac surgical risk scores identifying elderly patients at high risk of mortality and major morbidity. Circ Cardiovasc Qual Outcomes. 2013;5:222–8.

    Article  Google Scholar 

  28. The TIME Investigators. Trial of invasive versus medical therapy in elderly patients with chronic symptomatic coronary-artery disease (TIME): a randomized trial. Lancet. 2001;358:951–7.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Harald Rittger MD .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Rittger, H. (2015). CABG Versus PCI in Elderly Patients. In: Rittger, H. (eds) Interventional Cardiology in the Elderly. Springer, Cham. https://doi.org/10.1007/978-3-319-21142-8_7

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-21142-8_7

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-21141-1

  • Online ISBN: 978-3-319-21142-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics