Role of Comprehensive Geriatric Assessment in Evaluating the Efficacy of Treatment in Elderly Patients with Coronary Artery Disease

ABSTRACT

BACKGROUND: Although the elderly patients who need coronary revascularization are increasing, the effecti- veness and benefit of percutaneous coronary intervention(PCI) or coronary artery bypass surgery(CABG) in the elderly patients have not been evaluated by using comprehensive geriatric assessment. METHODS: From January 2007 to May 2007, 47 patients aged 65 years or older, who had stable angina with more than one coronary artery stenosis, were included in the current study. Comprehensive geriatric assess- ment, including medical, psychosocial, and functional evaluation, was performed by geriatric team. Patients were managed by medical treatment, PCI or CABG according to the decision of attending physician. One year clinical and laboratory evaluations were performed in all the study patients. RESULTS: Baseline characteristics were not significantly different among the medical treatment, PCI, or CABG group, except the extent of coronary artery disease(p=0.007). In addition, comprehensive geriatric assess- ment showed no difference in the three groups. During the follow-up period, major adverse cardiac events (MACE) were observed in 9 patients including 2 cases of cardiac death. Compared with medical treatment and PCI group, CABG group showed impaired ADL status. ADL independency was significantly impaired in CABG group; medical treatment group(84.6%-->91.7%), PCI group(85.2%-->76.9%), and CABG group(71.4%-->33.3%)(p=0.025). However, there was no other difference in cognition, depression, and nutritional status among the groups. CONCLUSION: Compared with medical treatment and PCI group, patients treated by CABG appeared functional dependency in the elderly patients. Effort to identify the risk factor and vulnerable patients should be emphasized especially in the elderly patients who need CABG.