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Updated: Mar 23, 2026
Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Long-term Outcome after Percutaneous Coronary Intervention Compared with Minimally Invasive Coronary Artery Bypass
Emad A Barsoum1, Basem Azab2, Nileshkumar Patel1
1Department of Medicine, Staten Island University Hospital, North Shore-LIJ Health System, Staten Island, New York, USA.
Insights
For elderly patients with severe coronary artery disease, percutaneous coronary intervention (PCI) and minimally invasive coronary artery bypass grafting (MICS-CABG) show similar long-term survival. However, PCI requires more repeat revascularization procedures.
Area of Science:
- Cardiology
- Geriatric Medicine
- Interventional Cardiology
Background:
- Elderly patients with unstable coronary artery disease (CAD) benefit from revascularization.
- Percutaneous coronary intervention (PCI) with drug-eluting stents is an option for the elderly.
- Minimally invasive coronary artery bypass grafting (MICS-CABG) is a safe alternative to conventional CABG.
Purpose of the Study:
- To compare long-term outcomes of PCI versus MICS-CABG in patients aged 75 and older with severe CAD.
Main Methods:
- Retrospective study of 175 elderly patients (≥75 years) undergoing PCI or MICS-CABG for severe CAD.
- Patients had Class-I indications for CABG.
- Follow-up was conducted for 5 years.
Main Results:
- No significant difference in 5-year all-cause mortality or survival between PCI and MICS-CABG groups.
- PCI group had shorter hospital stays and fewer discharges to rehabilitation.
- PCI group had a significantly higher rate of repeat revascularization (15% vs 3%).
Conclusions:
- Long-term all-cause mortality is similar for PCI and MICS-CABG in elderly patients with severe CAD.
- PCI is associated with a higher need for repeat revascularization compared to MICS-CABG.
Background:
Elderly patients with unstable coronary artery disease (CAD) have better outcomes with coronary revascularization than conservative treatment. With the improvement in percutaneous coronary intervention (PCI) techniques using drug eluting-stents, this became an attractive option in elderly. Minimally invasive coronary artery bypass grafting (MICS-CABG) is a safe and effective alternative to conventional CABG. We aimed to explore the long-term outcomes after PCI vs MICS-CABG in ≥75 year-old patients with severe CAD.
Methods:
A total of 1454 elderly patients (≥75 year-old patients) underwent coronary artery revascularization between January 2005 and December 2009. Patients were selected in the study if they have one of the Class-I indications for CABG. Groups were divided according to the type of procedure, PCI or MICS-CABG, and 5 year follow-up.
Results:
Among 175 elderly patients, 109 underwent PCI and 66 had MICS-CABG. There was no significant difference observed in both groups with long-term all-cause mortality (31 PCI vs 21% MICS-CABG, p=0.151) and the overall 5 year survival was similar on Kaplan-Meier curve (Log rank p=0.318). The average length of stay in hospital was significantly shorter in the PCI than in the MICS-CABG group (4.3 vs 7.8 days, p<0.001). Only 4.7% of the PCI group were discharged to rehabilitation facility compared with 43.9% of the MICS-CABG group (p<0.001). The rate of repeat revascularization was significantly higher in the PCI group than in the MICS-CABG group (15 vs 3%, p=0.014).
Conclusion:
Among elderly patients, long-term all-cause mortality is similar after PCI and MICS-CABG. However, there is a significantly higher rate of repeat revascularization after PCI.
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