Comparison of results of coronary artery bypass grafting versus percutaneous coronary intervention in octogenarians

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Surgery

Background:

• Elderly patients (≥80 years) undergoing revascularization present unique challenges.
• Comparing outcomes of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in this age group is crucial for treatment decisions.

Purpose of the Study:

• To compare the 30-day and intermediate-term outcomes of CABG versus PCI in patients aged 80 years and older.
• To identify factors influencing mortality and survival in elderly patients undergoing revascularization procedures.

Main Methods:

• Retrospective analysis of 274 isolated CABG patients and 393 PCI patients aged ≥80 years.
• Multivariate analysis and propensity score matching were used to adjust for baseline differences.
• Outcomes assessed included 30-day mortality and intermediate-term survival (5-year).

Main Results:

• Patients undergoing PCI had higher rates of prior cardiac surgery, recent myocardial infarction, and emergency revascularization.
• CABG patients more frequently had 3-vessel coronary artery disease.
• Unadjusted 30-day mortality was similar, but multivariate analysis showed increased risk with CABG.
• Unadjusted 5-year survival favored CABG, but propensity score-adjusted and matched analyses revealed similar intermediate survival rates between CABG and PCI.

Conclusions:

• In patients aged ≥80 years, both CABG and PCI can achieve similar intermediate survival rates when adjusted for clinical variables.
• The higher-risk profile of patients selected for PCI in unadjusted analyses may explain apparent survival differences.
• CABG demonstrates excellent survival in this elderly population, with PCI outcomes becoming comparable after risk adjustment.