Influence of age on the clinical outcomes of coronary revascularisation for the treatment of patients with multivessel de novo coronary artery lesions: sirolimus-eluting stent vs. coronary artery bypass surgery and bare metal stent, insight from the multicentre randomised Arterial Revascularisation Therapy Study Part I (ARTS-I) and Part II (ARTS-II)
2011 • In EuroIntervention: Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology, 5, p. 838-845
Ageing; Coronary artery disease; revascularisation; bare metal stent; sirolimus eluting stent; surgery
Abstract :
[en] Aims: We sought to evaluate the prognostic impact of age on the procedural results and subsequent clinical
outcomes in patients with multivessel disease (MVD) treated either by coronary artery bypass surgery (CABG) or
by percutaneous coronary intervention (PCI) with or without drug eluting stents, based on data of the Arterial
Revascularisation Therapies Study (ARTS) part I and part II. The potential influence of age in determining the most
appropriate revascularisation strategy for patients with MVD is largely unknown.
Methods and results: Three year clinical outcome of ARTS I patients randomised to PCI with bare metal stent
(BMS) (n= 600) or CABG (n= 605), and matched patients treated by PCI with sirolimus-eluting stents (SES) in
ARTS II (n= 607) were reviewed according to four age quartiles. Endpoints were measured in terms of major
adverse cardiac and cerebrovascular events MACCE) during hospital stay and up to three years. The frequency of
female, diabetes, hypertension, peripheral vascular disease, pulmonary disease, as well as lesion complexity
increased with age. At three years, MACCE free survival was comparable between patients treated by CABG or
SES PCI, regardless of age quartile. The incidence of MACCE was higher among ARTS I BMS treated patients in
all but the second age quartile. This was primarily related to a higher need for repeat revascularisation among BMS
treated patients. However, age, which emerged as a strong independent predictor of MACCE following CABG
(p<0.005), was not predictive of adverse events following PCI. Conversely, diabetes was the strongest independent
predictor of MACCE among PCI treated patients (p<0.02), but didn’t affect three-year outcomes following CABG.
Conclusions: Age seems to influence the CABG outcome in-hospital but not PCI. PCI-SES could offer lower
immediate risk in patients with MVD and comparable long-term outcome as CABG especially in older patients.
The worst outcome of PCI-BMS group is primarily related to the need for repeat revascularisation. Diabetes is the
most important predictor of MACCE following PCI.
Disciplines :
Cardiovascular & respiratory systems
Author, co-author :
Legrand, Victor ; Université de Liège - ULiège > Département des sciences cliniques > Cardiologie
Garg, Scott
Serruys, Patrick
Virtanen, Kari
Szurawitzki, Günter
Voudris, Vassilis
Fontanelli, Alessandro
Endersen, Knut
Kranjec, Igor
Rademaker, Tessa
Stefanidis, Christodoulos
Wittebols, Kristel
Language :
English
Title :
Influence of age on the clinical outcomes of coronary revascularisation for the treatment of patients with multivessel de novo coronary artery lesions: sirolimus-eluting stent vs. coronary artery bypass surgery and bare metal stent, insight from the multicentre randomised Arterial Revascularisation Therapy Study Part I (ARTS-I) and Part II (ARTS-II)
Publication date :
2011
Journal title :
EuroIntervention: Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology
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