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10-Year Follow-Up After Revascularization in Elderly Patients With Complex Coronary Artery Disease

Masafumi Ono1, Patrick W Serruys2, Hironori Hara1

  • 1Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland.

Journal of the American College of Cardiology
|June 4, 2021
PubMed

Insights

For elderly patients with complex coronary artery disease, percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) showed similar long-term outcomes. Both revascularization strategies offered comparable survival, major adverse events, and quality of life over 10 years.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Optimal revascularization strategy for elderly patients with complex coronary artery disease is not well-defined.
  • Elderly individuals (>70 years) with three-vessel disease (3VD) and/or left main disease (LMD) represent a significant clinical challenge.

Purpose of the Study:

  • To compare 10-year all-cause mortality, life expectancy, and 5-year major adverse cardiac or cerebrovascular events (MACCE) between percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG).
  • To assess 5-year quality of life (QOL) in elderly patients undergoing PCI versus CABG for complex coronary artery disease.

Main Methods:

  • Analysis of the SYNTAX Extended Survival study, comparing elderly and non-elderly patients.
  • Utilized Kaplan-Meier estimates and Cox proportional hazards models for mortality and MACCE.
  • Life expectancy estimated by restricted mean survival time; QOL assessed using the Seattle Angina Questionnaire and linear mixed-effects models.

Main Results:

  • In elderly patients, 10-year mortality was similar between PCI and CABG (44.1% vs. 41.1%).
  • Five-year MACCE rates were comparable for PCI and CABG in the elderly (39.4% vs. 35.1%).
  • No significant differences in life expectancy or 5-year QOL were observed between PCI and CABG in elderly patients.

Conclusions:

  • Elderly patients with 3VD and/or LMD experience similar 10-year mortality, life expectancy, 5-year MACCE, and 5-year QOL regardless of PCI or CABG revascularization.
  • These findings suggest that treatment choice can be individualized for elderly patients with complex coronary artery disease.
Abstract

Keywords:
CABGSYNTAXelderlylife expectancy, long-term outcome, PCI

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