Changes in Mortality after Myocardial Revascularization in the Elderly The National Medicare Experience

• Objective: To examine secular changes in the use and outcome of percutaneous transluminal coronary angioplasty and cardiac bypass graft surgery in the elderly. • Design: A retrospective cohort study based on a longitudinal database created from the administrative files of Medicare. • Setting: U.S. hospitals that perform myocardial re-vascularization procedures covered by Medicare. • Patients: 225 915 consecutive patients who had an-gioplasty and 357 885 consecutive patients who had bypass surgery from 1987 to 1990. • Measurements: The rates of angioplasty and bypass surgery use; unadjusted 30-day and 1-year mortality rates after revascularization; and adjusted odds ratios for mortality by year of procedure for 1987 to 1990. • Resuits: From 1987 to 1990, the rates of angioplasty and bypass surgery done in the elderly increased by 55 % and 18%, respectively. During this period, 30-day unadjusted mortality rates after angioplasty and by-pass surgery decreased by 25 % (95 % CI, 22 % to 28%) and 12 % (CI, 10 % to 14%), and 1-year mortality rate