PittsburghV1, France, Analysis, bibRecord, 000542

The Effect of Age on Outcomes of Coronary Artery CME Bypass Surgery Compared With Balloon Angioplasty or Bare-Metal Stent Implantation Among Patients With Multivessel Coronary Disease: A Collaborative Analysis of Individual Patient Data From 10 Randomized Trials

Identifieur interne : 000542 ( France/Analysis ); précédent : 000541; suivant : 000543

The Effect of Age on Outcomes of Coronary Artery CME Bypass Surgery Compared With Balloon Angioplasty or Bare-Metal Stent Implantation Among Patients With Multivessel Coronary Disease: A Collaborative Analysis of Individual Patient Data From 10 Randomized Trials

Auteurs : Marcus Flather [Royaume-Uni] ; June-Wha Rhee [États-Unis] ; Derek B. Boothroyd [États-Unis] ; Eric Boersma [Pays-Bas] ; Maria Mori Brooks [États-Unis] ; Didier Carrie [France] ; Tim C. Clayton [Royaume-Uni] ; Nicholas Danchin [France] ; Christian W. Hamm [Allemagne] ; Whady A. Hueb [Brésil] ; Spencer B. King [Géorgie] ; Stuart J. Pocock [Royaume-Uni] ; Alfredo E. Rodriguez [Argentine] ; Patrick Serruys [Pays-Bas] ; Ulrich Sigwart [Suisse] ; Rodney H. Stables [Royaume-Uni] ; Mark A. Hlatky [États-Unis]

Source :

Journal of the American College of Cardiology [ 0735-1097 ] ; 2012.

RBID : Pascal:13-0018142

Descripteurs français

Pascal (Inist)
- Cardiopathie coronaire, Age, Pronostic, Etude comparative, Angioplastie, Métal, Stent, Endoprothèse, Implantation, Homme, Malade, Coopération, Analyse, Individu, Donnée, Randomisation, Appareil circulatoire, Cardiologie, Traitement instrumental, Pontage coronarien.
Wicri :
- topic : Métal, Homme.

English descriptors

KwdEn :
- Age, Analysis, Angioplasty, Cardiology, Circulatory system, Comparative study, Cooperation, Coronary artery bypass, Coronary heart disease, Data, Endoprosthesis, Human, Implantation, Individual, Instrumentation therapy, Metal, Patient, Prognosis, Randomization, Stent.

Abstract

Objectives This study sought to assess whether patient age modifies the comparative effectiveness of coronary artery bypass graft (CABG) surgery and percutaneous coronary intervention (PCI). Background Increasingly, CABG and PCI are performed in older patients to treat multivessel disease, but their comparative effectiveness is uncertain. Methods Individual 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. Results Older 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. Conclusions Patient 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.

Affiliations:

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Pascal:13-0018142

Le document en format XML

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<author><name sortKey="Sigwart, Ulrich" sort="Sigwart, Ulrich" uniqKey="Sigwart U" first="Ulrich" last="Sigwart">Ulrich Sigwart</name>
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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a">The Effect of Age on Outcomes of Coronary Artery CME Bypass Surgery Compared With Balloon Angioplasty or Bare-Metal Stent Implantation Among Patients With Multivessel Coronary Disease: A Collaborative Analysis of Individual Patient Data From 10 Randomized Trials</title>
<author><name sortKey="Flather, Marcus" sort="Flather, Marcus" uniqKey="Flather M" first="Marcus" last="Flather">Marcus Flather</name>
<affiliation wicri:level="1"><inist:fA14 i1="01"><s1>University of East Anglia</s1>
<s2>Norwich</s2>
<s3>GBR</s3>
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<country>Royaume-Uni</country>
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</affiliation>
</author>
<author><name sortKey="Rhee, June Wha" sort="Rhee, June Wha" uniqKey="Rhee J" first="June-Wha" last="Rhee">June-Wha Rhee</name>
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<s2>Stanford, California</s2>
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<author><name sortKey="Boothroyd, Derek B" sort="Boothroyd, Derek B" uniqKey="Boothroyd D" first="Derek B." last="Boothroyd">Derek B. Boothroyd</name>
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<author><name sortKey="Boersma, Eric" sort="Boersma, Eric" uniqKey="Boersma E" first="Eric" last="Boersma">Eric Boersma</name>
<affiliation wicri:level="3"><inist:fA14 i1="03"><s1>Erasmus Medical Center</s1>
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<author><name sortKey="Mori Brooks, Maria" sort="Mori Brooks, Maria" uniqKey="Mori Brooks M" first="Maria" last="Mori Brooks">Maria Mori Brooks</name>
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<author><name sortKey="Carrie, Didier" sort="Carrie, Didier" uniqKey="Carrie D" first="Didier" last="Carrie">Didier Carrie</name>
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</inist:fA14>
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</placeName>
</affiliation>
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<author><name sortKey="Clayton, Tim C" sort="Clayton, Tim C" uniqKey="Clayton T" first="Tim C." last="Clayton">Tim C. Clayton</name>
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<author><name sortKey="Danchin, Nicholas" sort="Danchin, Nicholas" uniqKey="Danchin N" first="Nicholas" last="Danchin">Nicholas Danchin</name>
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<placeName><region type="region">Île-de-France</region>
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<author><name sortKey="Hamm, Christian W" sort="Hamm, Christian W" uniqKey="Hamm C" first="Christian W." last="Hamm">Christian W. Hamm</name>
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<author><name sortKey="Hueb, Whady A" sort="Hueb, Whady A" uniqKey="Hueb W" first="Whady A." last="Hueb">Whady A. Hueb</name>
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<author><name sortKey="King, Spencer B" sort="King, Spencer B" uniqKey="King S" first="Spencer B." last="King">Spencer B. King</name>
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<country>Géorgie</country>
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</author>
<author><name sortKey="Pocock, Stuart J" sort="Pocock, Stuart J" uniqKey="Pocock S" first="Stuart J." last="Pocock">Stuart J. Pocock</name>
<affiliation wicri:level="3"><inist:fA14 i1="06"><s1>London School of Hygiene and Tropical Medicine</s1>
<s2>London</s2>
<s3>GBR</s3>
<sZ>7 aut.</sZ>
<sZ>12 aut.</sZ>
</inist:fA14>
<country>Royaume-Uni</country>
<placeName><settlement type="city">Londres</settlement>
<region type="country">Angleterre</region>
<region type="région" nuts="1">Grand Londres</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Rodriguez, Alfredo E" sort="Rodriguez, Alfredo E" uniqKey="Rodriguez A" first="Alfredo E." last="Rodriguez">Alfredo E. Rodriguez</name>
<affiliation wicri:level="1"><inist:fA14 i1="11"><s1>Sanatario Otamendi, Buenos Aires</s1>
<s3>ARG</s3>
<sZ>13 aut.</sZ>
</inist:fA14>
<country>Argentine</country>
<wicri:noRegion>Sanatario Otamendi, Buenos Aires</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Serruys, Patrick" sort="Serruys, Patrick" uniqKey="Serruys P" first="Patrick" last="Serruys">Patrick Serruys</name>
<affiliation wicri:level="3"><inist:fA14 i1="03"><s1>Erasmus Medical Center</s1>
<s2>Rotterdam</s2>
<s3>NLD</s3>
<sZ>4 aut.</sZ>
<sZ>14 aut.</sZ>
</inist:fA14>
<country>Pays-Bas</country>
<placeName><settlement type="city">Rotterdam</settlement>
<region nuts="2" type="province">Hollande-Méridionale</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Sigwart, Ulrich" sort="Sigwart, Ulrich" uniqKey="Sigwart U" first="Ulrich" last="Sigwart">Ulrich Sigwart</name>
<affiliation wicri:level="4"><inist:fA14 i1="12"><s1>Université de Geneve</s1>
<s2>Geneva</s2>
<s3>CHE</s3>
<sZ>15 aut.</sZ>
</inist:fA14>
<country>Suisse</country>
<placeName><settlement type="city">Genève</settlement>
<region nuts="3" type="region">Canton de Genève</region>
</placeName>
<orgName type="university">Université de Genève</orgName>
</affiliation>
</author>
<author><name sortKey="Stables, Rodney H" sort="Stables, Rodney H" uniqKey="Stables R" first="Rodney H." last="Stables">Rodney H. Stables</name>
<affiliation wicri:level="1"><inist:fA14 i1="13"><s1>Liverpool Heart and Chest Hospital</s1>
<s2>Liverpool</s2>
<s3>GBR</s3>
<sZ>16 aut.</sZ>
</inist:fA14>
<country>Royaume-Uni</country>
<wicri:noRegion>Liverpool Heart and Chest Hospital</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Hlatky, Mark A" sort="Hlatky, Mark A" uniqKey="Hlatky M" first="Mark A." last="Hlatky">Mark A. Hlatky</name>
<affiliation wicri:level="2"><inist:fA14 i1="02"><s1>Stanford University School of Medicine</s1>
<s2>Stanford, California</s2>
<s3>USA</s3>
<sZ>2 aut.</sZ>
<sZ>3 aut.</sZ>
<sZ>17 aut.</sZ>
</inist:fA14>
<country>États-Unis</country>
<placeName><region type="state">Californie</region>
</placeName>
</affiliation>
</author>
</analytic>
<series><title level="j" type="main">Journal of the American College of Cardiology</title>
<title level="j" type="abbreviated">J. Am. Coll. Cardiol.</title>
<idno type="ISSN">0735-1097</idno>
<imprint><date when="2012">2012</date>
</imprint>
</series>
</biblStruct>
</sourceDesc>
<seriesStmt><title level="j" type="main">Journal of the American College of Cardiology</title>
<title level="j" type="abbreviated">J. Am. Coll. Cardiol.</title>
<idno type="ISSN">0735-1097</idno>
</seriesStmt>
</fileDesc>
<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Age</term>
<term>Analysis</term>
<term>Angioplasty</term>
<term>Cardiology</term>
<term>Circulatory system</term>
<term>Comparative study</term>
<term>Cooperation</term>
<term>Coronary artery bypass</term>
<term>Coronary heart disease</term>
<term>Data</term>
<term>Endoprosthesis</term>
<term>Human</term>
<term>Implantation</term>
<term>Individual</term>
<term>Instrumentation therapy</term>
<term>Metal</term>
<term>Patient</term>
<term>Prognosis</term>
<term>Randomization</term>
<term>Stent</term>
</keywords>
<keywords scheme="Pascal" xml:lang="fr"><term>Cardiopathie coronaire</term>
<term>Age</term>
<term>Pronostic</term>
<term>Etude comparative</term>
<term>Angioplastie</term>
<term>Métal</term>
<term>Stent</term>
<term>Endoprothèse</term>
<term>Implantation</term>
<term>Homme</term>
<term>Malade</term>
<term>Coopération</term>
<term>Analyse</term>
<term>Individu</term>
<term>Donnée</term>
<term>Randomisation</term>
<term>Appareil circulatoire</term>
<term>Cardiologie</term>
<term>Traitement instrumental</term>
<term>Pontage coronarien</term>
</keywords>
<keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Métal</term>
<term>Homme</term>
</keywords>
</textClass>
</profileDesc>
</teiHeader>
<front><div type="abstract" xml:lang="en">Objectives This study sought to assess whether patient age modifies the comparative effectiveness of coronary artery bypass graft (CABG) surgery and percutaneous coronary intervention (PCI). Background Increasingly, CABG and PCI are performed in older patients to treat multivessel disease, but their comparative effectiveness is uncertain. Methods Individual 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. Results Older 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. Conclusions Patient 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.</div>
</front>
</TEI>
<affiliations><list><country><li>Allemagne</li>
<li>Argentine</li>
<li>Brésil</li>
<li>France</li>
<li>Géorgie</li>
<li>Pays-Bas</li>
<li>Royaume-Uni</li>
<li>Suisse</li>
<li>États-Unis</li>
</country>
<region><li>Angleterre</li>
<li>Californie</li>
<li>Canton de Genève</li>
<li>Grand Londres</li>
<li>Hollande-Méridionale</li>
<li>Midi-Pyrénées</li>
<li>Occitanie (région administrative)</li>
<li>Pennsylvanie</li>
<li>État de São Paulo</li>
<li>Île-de-France</li>
</region>
<settlement><li>Genève</li>
<li>Londres</li>
<li>Paris</li>
<li>Rotterdam</li>
<li>São Paulo</li>
<li>Toulouse</li>
</settlement>
<orgName><li>Université Paris-Descartes</li>
<li>Université de Genève</li>
</orgName>
</list>
<tree><country name="Royaume-Uni"><noRegion><name sortKey="Flather, Marcus" sort="Flather, Marcus" uniqKey="Flather M" first="Marcus" last="Flather">Marcus Flather</name>
</noRegion>
<name sortKey="Clayton, Tim C" sort="Clayton, Tim C" uniqKey="Clayton T" first="Tim C." last="Clayton">Tim C. Clayton</name>
<name sortKey="Pocock, Stuart J" sort="Pocock, Stuart J" uniqKey="Pocock S" first="Stuart J." last="Pocock">Stuart J. Pocock</name>
<name sortKey="Stables, Rodney H" sort="Stables, Rodney H" uniqKey="Stables R" first="Rodney H." last="Stables">Rodney H. Stables</name>
</country>
<country name="États-Unis"><region name="Californie"><name sortKey="Rhee, June Wha" sort="Rhee, June Wha" uniqKey="Rhee J" first="June-Wha" last="Rhee">June-Wha Rhee</name>
</region>
<name sortKey="Boothroyd, Derek B" sort="Boothroyd, Derek B" uniqKey="Boothroyd D" first="Derek B." last="Boothroyd">Derek B. Boothroyd</name>
<name sortKey="Hlatky, Mark A" sort="Hlatky, Mark A" uniqKey="Hlatky M" first="Mark A." last="Hlatky">Mark A. Hlatky</name>
<name sortKey="Mori Brooks, Maria" sort="Mori Brooks, Maria" uniqKey="Mori Brooks M" first="Maria" last="Mori Brooks">Maria Mori Brooks</name>
</country>
<country name="Pays-Bas"><region name="Hollande-Méridionale"><name sortKey="Boersma, Eric" sort="Boersma, Eric" uniqKey="Boersma E" first="Eric" last="Boersma">Eric Boersma</name>
</region>
<name sortKey="Serruys, Patrick" sort="Serruys, Patrick" uniqKey="Serruys P" first="Patrick" last="Serruys">Patrick Serruys</name>
</country>
<country name="France"><region name="Occitanie (région administrative)"><name sortKey="Carrie, Didier" sort="Carrie, Didier" uniqKey="Carrie D" first="Didier" last="Carrie">Didier Carrie</name>
</region>
<name sortKey="Danchin, Nicholas" sort="Danchin, Nicholas" uniqKey="Danchin N" first="Nicholas" last="Danchin">Nicholas Danchin</name>
</country>
<country name="Allemagne"><noRegion><name sortKey="Hamm, Christian W" sort="Hamm, Christian W" uniqKey="Hamm C" first="Christian W." last="Hamm">Christian W. Hamm</name>
</noRegion>
</country>
<country name="Brésil"><region name="État de São Paulo"><name sortKey="Hueb, Whady A" sort="Hueb, Whady A" uniqKey="Hueb W" first="Whady A." last="Hueb">Whady A. Hueb</name>
</region>
</country>
<country name="Géorgie"><noRegion><name sortKey="King, Spencer B" sort="King, Spencer B" uniqKey="King S" first="Spencer B." last="King">Spencer B. King</name>
</noRegion>
</country>
<country name="Argentine"><noRegion><name sortKey="Rodriguez, Alfredo E" sort="Rodriguez, Alfredo E" uniqKey="Rodriguez A" first="Alfredo E." last="Rodriguez">Alfredo E. Rodriguez</name>
</noRegion>
</country>
<country name="Suisse"><region name="Canton de Genève"><name sortKey="Sigwart, Ulrich" sort="Sigwart, Ulrich" uniqKey="Sigwart U" first="Ulrich" last="Sigwart">Ulrich Sigwart</name>
</region>
</country>
</tree>
</affiliations>
</record>

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   |texte=   The Effect of Age on Outcomes of Coronary Artery CME Bypass Surgery Compared With Balloon Angioplasty or Bare-Metal Stent Implantation Among Patients With Multivessel Coronary Disease: A Collaborative Analysis of Individual Patient Data From 10 Randomized Trials
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The Effect of Age on Outcomes of Coronary Artery CME Bypass Surgery Compared With Balloon Angioplasty or Bare-Metal Stent Implantation Among Patients With Multivessel Coronary Disease: A Collaborative Analysis of Individual Patient Data From 10 Randomized Trials

The Effect of Age on Outcomes of Coronary Artery CME Bypass Surgery Compared With Balloon Angioplasty or Bare-Metal Stent Implantation Among Patients With Multivessel Coronary Disease: A Collaborative Analysis of Individual Patient Data From 10 Randomized Trials

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