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Published on: March 27, 2018
Long-term follow-up after bypass surgery or coronary stenting in elderly with multivessel disease
M E Gimbel1, L M Willemsen2, M C Daggelders2
1Department of Cardiology and Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands. m.gimbel@antoniusziekenhuis.nl.
Insights
Long-term outcomes show higher mortality for elderly patients undergoing percutaneous coronary intervention (PCI) compared to coronary artery bypass grafting (CABG) for left main or multivessel disease.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Elderly patients (≥75 years) with complex coronary artery disease (left main or multivessel disease) require careful treatment selection.
- Long-term follow-up data comparing coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in this demographic are crucial.
Purpose of the Study:
- To compare the long-term outcomes of CABG versus PCI in elderly patients with left main or multivessel coronary artery disease.
- To identify predictors of adverse outcomes, including completeness of revascularization and coronary artery disease severity.
Main Methods:
- Retrospective cohort study of 597 patients aged ≥75 years undergoing PCI or CABG between 2012-2016.
- Primary outcome: all-cause mortality at 5-year follow-up.
- Secondary outcomes included major adverse cardiac and cerebral events, bleeding, recurrent angina, and new onset atrial fibrillation.
Main Results:
- Five-year mortality was significantly higher after PCI (39.9%) compared to CABG (25.4%) (p < 0.001).
- Acute coronary syndrome, repeat revascularization, and recurrent angina were more frequent post-PCI.
- Bleeding and new onset atrial fibrillation were more frequent post-CABG.
Conclusions:
- Coronary artery bypass grafting is associated with lower long-term mortality in elderly patients with left main or multivessel disease compared to percutaneous coronary intervention.
- Percutaneous coronary intervention in this population was linked to increased risks of acute coronary syndrome, repeat revascularization, and recurrent angina.
Background:
We sought to compare long-term follow-up of coronary artery bypass grafting (CABG) with percutaneous coronary intervention (PCI) in elderly patients with left main or multivessel disease, hypothesising that completeness of revascularisation and severity of coronary artery disease are predictors of adverse outcomes.
Methods:
Patients aged ≥75 years with multivessel disease or left main disease who underwent PCI or CABG between 2012-2016 were included in this retrospective cohort study. Baseline characteristics from the index procedure were collected. Severity of coronary artery disease and completeness of revascularisation were assessed. Primary outcome was all-cause mortality, in addition we captured major adverse cardiac and cerebral events, bleedings, recurrent angina and new onset atrial fibrillation.
Results:
A total of 597 patients were included. Median follow-up was 4 years (interquartile range 2.8-5.3 years). At baseline, patients in the PCI group more often had a previous medical history of CABG and more frequently underwent an urgent procedure compared with patients in the CABG group. Mortality at 5‑year follow-up was significantly higher in patients who underwent PCI compared with CABG (39.9% vs 25.4%, p < 0.001). Furthermore, acute coronary syndrome (ACS), repeat revascularisation and recurrent angina occurred more frequently after PCI, while occurrence of bleedings and new onset atrial fibrillation were more frequent after CABG. Neither completeness of revascularisation nor severity of coronary artery disease was a predictor for any of the outcomes.
Conclusion:
Long-term mortality was higher in elderly patients with multivessel disease undergoing PCI compared with CABG. In addition, patients undergoing PCI had a higher risk of ACS, repeat revascularisation and recurrent angina.
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