Long-Term Outcomes of Percutaneous Coronary Interventions or Coronary Artery Bypass Grafting for Left Main Coronary Artery Disease in Octogenarians (from a Drug-Eluting stent for LefT main Artery Registry Substudy) Federico Conrotto, MD a, *, Paolo Scacciatella, MD a , Fabrizio D’Ascenzo, MD b , Alaide Chieffo, MD, PhD c , Azeem Latib, MD, PhD c , Seung Jung Park, MD d , Young Hak Kim, MD d , Yoshinobu Onuma, MD, PhD e , Piera Capranzano, MD f , Sanda Jegere, MD g,h , Raj Makkar, MD i , Igor Palacios, MD j , Pawel Buszman, MD k , Tarun Chakravarty, MD i , Roxana Mehran, MD l , Christoph Naber, MD m , Ronan Margey, MD j , Martin Leon, MD l , Jeffrey Moses, MD l , Jean Fajadet, MD n , Thierry Lefèvre, MD o , Marie Claude Morice, MD o , Andrejs Erglis, MD g,h , Corrado Tamburino, MD f , Ottavio Alfieri, MD c , Maurizio D’Amico, MD a , Sebastiano Marra, MD a , Patrick W. Serruys, MD, PhD e , Antonio Colombo, MD c , and Emanuele Meliga, MD, PhD p Percutaneous coronary intervention (PCI) with drug-eluting stents is an accepted alter- native to surgery for the treatment of unprotected left main coronary artery (ULMCA) disease, but the long-term outcome in elderly patients is unclear. Aim of our study was to compare the clinical outcomes of octogenarians with ULMCA disease treated either with PCI with drug-eluting stents or coronary artery bypass grafting (CABG). The primary study end point was the composite of death, cerebrovascular accident, and myocardial infarction at follow-up. A total of 304 consecutive patients with ULMCA stenosis treated with PCI or CABG and aged ‡80 years were selected and analyzed in a large multinational registry. Two hundred eighteen were treated with PCI and 86 with CABG. During the hospitalization, a trend toward a higher mortality rate was reported in PCI-treated patients (3.5% vs 7.3%, p [ 0.32). At a median follow-up of 1,088 days, the incidence of the primary end point was similar in the 2 groups (32.6% vs 30.2%, p [ 0.69). Incidence of target vessel revascularization at follow-up was higher in PCI-treated patients (10% vs 4.2%, p [ 0.05). At multivariate analysis, left ventricular ejection fraction was the only independent predictor of the primary end point (hazard ratio 0.95, 95% confidence interval 0.91 to 0.98, p [ 0.001). After adjustment with propensity score, the revascularization strategy was not significantly correlated to the incidence of the primary end point (hazard ratio 0.98, 95% confidence interval 0.57 to 1.71, p [ 0.95). In octogenarians, no difference was observed in the occurrence of the primary end point after PCI or CABG for the treatment of ULMCA disease. However, the rate of target vessel revascularization was higher in the PCI group. Ó 2014 Elsevier Inc. All rights reserved. (Am J Cardiol 2014;-:-e-) The incidence of left main disease increases with age, 1 but elderly patients are commonly underrepresented in studies comparing outcomes after percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). 2 To date, only few registries 3e7 have specifically evaluated risks and benefits of PCI and CABG in patients >70 years with unprotected left main coronary artery (ULMCA) disease, and only 1 study was conducted in octogenarians. 8 This high-risk population could obtain a large benefit from less invasive procedures as very elderly a Department of Cardiology, Città della Salute e della Scienza Hospital, Turin, Italy; b Division of Cardiology, Department of Internal Medicine, University of Turin, Turin, Italy; c Department of Cardio-Thoracic and Vascular Diseases, San Raffaele Scientific Institute, Milan, Italy; d Depart- ment of Cardiology, Center for Medical Research and Information, Uni- versity of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; e Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands; f Ferrarotto Hospital, University of Catania, Catania, Italy; g Latvian Centre of Cardiology, Pauls Stradins Clinical University Hospital, Riga, Latvia; h Institute of Cardiology, University of Latvia, Riga, Latvia; i Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California; j Cardiac Catheterization Laboratory, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; k American Heart of Poland, Medical University of Silesia, Katowice, Poland; l Columbia Uni- versity Medical Center and Cardiovascular Research Foundation, New York, New York; m Department of Cardiology, University Hospital, Essen, Germany; n Clinique Pasteur, Toulouse, France; o Institut Hospitalier Jacques Cartier, Massy, France; and p Interventional Cardiology Unit, A.O. Ordine Mauriziano Umberto I, Turin, Italy. Manuscript received January 17, 2014; revised manuscript received and accepted March 8, 2014. See page 5 for disclosure information. *Corresponding author: Tel: (þ39) 0116335564; fax: (þ39) 0116335565. E-mail address: federico.conrotto@gmail.com (F. Conrotto). 0002-9149/14/$ - see front matter Ó 2014 Elsevier Inc. All rights reserved. www.ajconline.org http://dx.doi.org/10.1016/j.amjcard.2014.03.044