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Revascularization Strategies for Multivessel Coronary Artery Disease in the Elderly Population

Nicholas R Hess1, Arman Kilic2, Yisi Wang3

  • 1Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine.

The Journal of Surgical Research
|November 19, 2021
PubMed

Insights

Coronary artery bypass grafting (CABG) offers improved 5-year survival for elderly patients with multivessel coronary disease compared to percutaneous coronary intervention (PCI). Multidisciplinary evaluation is recommended for older patients with multivessel coronary disease.

Area of Science:

  • Cardiology
  • Geriatric Medicine
  • Interventional Cardiology

Background:

  • Previous trials on coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) for multivessel coronary disease (MVCAD) primarily included younger patients.
  • The elderly population's treatment strategies for MVCAD remain understudied.

Purpose of the Study:

  • To compare the effectiveness of CABG and PCI in elderly patients (≥75 years) with MVCAD.
  • To evaluate long-term survival and adverse events in this demographic.

Main Methods:

  • A propensity-score-matched analysis of patients ≥75 years undergoing isolated CABG or PCI for MVCAD between 2011 and 2018.
  • Exclusion criteria included prior cardiac surgery and significant left main disease.
  • Primary outcome: 5-year Kaplan-Meier survival; Secondary outcomes: readmissions and major adverse cardiovascular and cerebrovascular events (MACCE).

Main Results:

  • Propensity matching included 536 patients (266 PCI, 266 CABG).
  • CABG achieved higher complete revascularization rates (86.8% vs. 21.8%).
  • Five-year survival was significantly higher with CABG (73.8% vs. 60.1%, P=0.0332), despite similar 30-day mortality and shorter hospital stays with PCI.

Conclusions:

  • CABG is associated with improved late survival in elderly patients with MVCAD compared to PCI, despite longer hospitalization.
  • Cardiac surgeons should be involved in the multidisciplinary evaluation of older patients with MVCAD.
  • No significant 5-year survival benefit was observed from multi-arterial grafting in CABG patients.
Abstract

Keywords:
Coronary artery bypass graftCoronary artery diseaseCoronary stentsElderlyPercutaneous coronary interventionSurvival

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