P3476Long-term survival benefit of CTO revascularisation vs. conservative treatment in elderly patients

Le résumé fourni par la source

Background: Chronic total occlusions (CTO) are present in >30% of elderly patients with myocardial ischemia. There is still controversy regarding the best therapeutic approach in this setting. Aims: To compare long term survival of CTO revascularization (PCI or CABG) versus medical treatment (MT) in the old population. Methods and results: From 2010 to 2014, 1.252 patients with at least one CTO were identified (26% ≥75 years). The received treatment (PCI, CABG or MT) and clinical variables were analyzed according to age (≥ or <75 years). Global and cardiovascular (CV) mortality and rates of MACE were assessed during a median follow-up of 3.5 years. Older patients were more commonly treated with MT (71 vs 43%; p<0.001). Among patients ≥75 years, 29% underwent revascularization. These subjects were younger, had higher LVEF and lower ACEF scores compared to the MT group (p<0.05). Global mortality was lower with CABG or PCI compared to MT (HR 0.35, IC 0.17–0.71 and HR 0.57, IC 0.33–0.98, respectively). No differences in mortality were observed according to type of procedure. The intervention group had lower rates of MACE (HR 0.39, IC 0.22–0.68 for CABG and HR 0.48, IC 0.26–0.91 for PCI). CV mortality was lower in the CABG group (HR 0.39; IC 0.18–0.81) compared to MT. A non-significant reduction of CV mortality was also observed in the PCI group (HR 0.59, IC 0.28–1.2).

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