Coronary artery bypass grafting versus angioplasty versus medical treatment in elderly with coronary artery disease / Patricia J. Agunod, Ramoncito B. Tria, Christopher C. Cheng

This retrospective study included 215 patients older than 70 years with angiographically proven coronary artery disease at the Philippine Heart Center from January 1992 until December 1995. One hundred eight were treated medically, 68 surgically (CABG) and 39 underwent angioplasty (PTCA). Results were analyzed to determine early morbidity, early and late survival and adverse cardiac events, functional outcome, and risk factors for in-hospital mortality. The three treatment groups were similar except for more females and more utilization of intra-aortic balloon counterpulsation and inotropes in the PTCA group. The PTCA and CABG groups had more patients in functional class IV and in need of urgent revascularization. The CABG group had more left main coronary artery involvement. Despite an increased in-hospital and 30-day mortality and morbidity, there was a significantly greater improvement in functional class for both CABG and PTCA groups. However, 4-year survival and freedom from adverse cardiac events were not significantly different from the medical group. For patients subjected to CABG, predictors of in-hospital mortality included ejection fraction, urgent revascularization, pre-operative need for intravenous nitrates, NYHA functional class IV, chronic renal insufficiency, and in-hospital morbidities. For the angioplasty group, predictors of mortality include pre-angioplasty hypotension, use of intra-aortic balloon pump and inotropes, urgent revascularization, and functional class

Nursing.