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Updated: Oct 17, 2025
Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Five-year outcomes after coronary artery bypass grafting and percutaneous coronary intervention in octogenarians with
Hiroyuki Hara1, Hiroki Watanabe2, Jiro Esaki3
1Division of Cardiovascular Surgery, Japan Red Cross Society Wakayama Medical Center, Wakayama, Japan.
Insights
Coronary artery bypass grafting (CABG) in octogenarians with severe coronary artery disease showed a lower adjusted risk for death and adverse cardiac events compared to percutaneous coronary intervention (PCI). CABG is a viable option for selected elderly patients.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Geriatric Cardiology
Background:
- Severe coronary artery disease (triple-vessel disease or left main coronary artery disease) poses significant risks in octogenarians.
- Treatment decisions for elderly patients require careful consideration of procedural risks and long-term outcomes.
Purpose of the Study:
- To compare the clinical effectiveness of coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) in octogenarians (≥80 years) with triple-vessel disease (TVD) or left main coronary artery (LMCA) disease.
Main Methods:
- Analysis of 527 octogenarian patients from the CREDO-Kyoto registry cohort-2 who underwent initial coronary revascularization for TVD or LMCA disease.
- Patients were divided into two groups: CABG (N=151) and PCI (N=376).
- Outcomes including all-cause death, cardiac death/myocardial infarction (MI), and need for revascularization were assessed over 5 years, with adjustment for confounders.
Main Results:
- The 5-year cumulative incidence of all-cause death was similar between groups (35.8% vs. 42.9%).
- CABG demonstrated a significantly lower rate of composite cardiac death/MI (21.7% vs. 33.9%) and any repeat coronary revascularization compared to PCI.
- Adjusted analysis revealed that CABG was associated with a significantly lower risk of all-cause death (HR 0.61), any coronary revascularization (HR 0.25), and composite cardiac death/MI (HR 0.52) compared to PCI.
Conclusions:
- Coronary artery bypass grafting (CABG) is associated with a lower adjusted risk of all-cause death, repeat revascularization, and major adverse cardiac events compared to percutaneous coronary intervention (PCI) in octogenarians with severe coronary artery disease.
- CABG represents an acceptable treatment option for carefully selected octogenarian patients with TVD or LMCA disease.
Objective:
We assessed the clinical effectiveness of coronary artery bypass grafting (CABG) in comparison with that of percutaneous coronary intervention (PCI) in octogenarians with triple-vessel disease (TVD) or left main coronary artery (LMCA) disease.
Methods:
From the CREDO-Kyoto registry cohort-2, 527 patients, who were ≥ 80 years of age and underwent the first coronary revascularization for TVD or LMCA disease, were divided into the CABG group (N = 151) and the PCI group (N = 376).
Results:
The median and interquartile range of patient's age was 82 (81-84) in the CABG group and 83 (81-85) in the PCI group (P = 0.10). Patients > = 85 years of age accounted for 19% and 31% in the CABG and PCI groups, respectively (P = 0.01). The cumulative 5-year incidence of all-cause death was similar between CABG and PCI groups (35.8% vs. 42.9%, log-rank P = 0.18), while CABG showed a lower rate of the composite of cardiac death/MI than PCI (21.7% vs. 33.9%, log-rank P = 0.005). After adjusting for confounders, the lower risk of CABG relative to PCI was significant for all-cause death (HR 0.61, 95% CI 0.43-0.86, P = 0.005), any coronary revascularization (HR 0.25, 95% CI 0.14-0.43, P < 0.001) and the composite of cardiac death/MI (HR 0.52, 95% CI 0.32-0.85, P = 0.009).
Conclusions:
CABG compared with PCI was associated with a lower adjusted risk for all-cause death, any coronary revascularization, and a composite of cardiac death/MI in very elderly patients with TVD or LMCA disease. CABG seemed an acceptable option for selected octogenarians with severe coronary artery disease.
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