Age, Diabetes May Affect Coronary Disease Treatments

Mortality among diabetics and older patients is lower with coronary artery bypass graft than with percutaneous coronary intervention

27 mar 2009-- In most patients with multivessel coronary disease who are suitable for either coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI), long-term mortality is similar for either treatment. In diabetics and older patients, however, CABG may be associated with a significant survival advantage, according to an article published online March 20 in The Lancet.

Mark A. Hlatky, M.D., of the Stanford University School of Medicine in Stanford, Calif., and colleagues conducted a meta-analysis of 10 randomized trials involving 7,812 patients. PCI was performed with balloon angioplasty in six trials and with bare-metal stents in four trials.

After a median follow-up of 5.9 years, the researchers found that mortality was not significantly different in the CABG and PCI groups (15 percent versus 16 percent). But they found that CABG was associated with significantly lower mortality among diabetics (hazard ratio, 0.70) and in patients aged 55 to 64, and 65 and older (hazard ratios, 0.90 and 0.82, respectively).

"Our finding that patient age modifies the relative effectiveness of CABG and PCI on survival has not previously been reported by individual randomized trials," the authors write. "The interaction of age with assigned treatment might be mediated by the more favorable clinical characteristics in younger patients; however, we found that the effect persisted after multivariable adjustment for such characteristics."

Abstract
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