Comparing outcomes between coronary artery bypass grafting and percutaneous coronary intervention in octogenarians...

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Cardiac Surgery

Background:

• Coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are primary revascularization strategies for coronary artery disease (CAD).
• CABG's mechanism involves surgical collateralization, potentially preventing future myocardial infarctions (MI) and prolonging life.
• The comparative effectiveness of CABG versus PCI in octogenarians, a population with perceived higher surgical risk, remains debated.

Purpose of the Study:

• To compare the long-term outcomes of CABG and PCI in octogenarians with left main or multivessel coronary artery disease.
• To evaluate differences in late mortality, perioperative mortality, myocardial infarction, re-revascularization, acute renal failure, and stroke between the two procedures.

Main Methods:

• A meta-analysis was conducted, pooling data from fourteen studies encompassing 17,942 patients.
• Primary outcome was late mortality (greater than 5 years); secondary outcomes included perioperative mortality, MI, re-revascularization (R-R), acute renal failure (ARF), and stroke.
• Pooled Kaplan-Meier and landmark analyses were performed to assess survival differences over time.

Main Results:

• CABG was associated with significantly lower late mortality (HR: 1.23, P < 0.01) and a reduced risk of death during long-term follow-up (HR: 1.08, P = 0.005).
• Landmark analyses confirmed a survival advantage for CABG after 21.5 months, but PCI showed an early advantage within 30 days (HR: 0.72, P < 0.0001).
• CABG demonstrated lower risks of MI and R-R but was linked to higher perioperative mortality; no significant differences were observed for ARF and stroke.

Conclusions:

• In octogenarians with complex coronary artery disease, CABG appears to be superior to PCI in terms of long-term survival.
• This survival benefit of CABG is associated with fewer myocardial infarctions and re-revascularization events.
• The advantage of CABG comes with an increased risk of perioperative mortality, necessitating careful patient selection.