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Revascularization in Patients Over 75 With Acute Coronary Syndrome

Samantha Pozo Navarro1, Kendall Hammonds2, Timothy Mixon3

  • 1Naresh K. Vashisht College of Medicine, Texas A&M University, Bryan, Texas.

The American Journal of Cardiology
|December 14, 2025
PubMed

Insights

Coronary artery bypass grafting (CABG) shows improved outcomes for acute coronary syndromes (ACS) and multivessel coronary artery disease (MV-CAD) in patients over 75. CABG is a safe and effective revascularization strategy across age groups.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Geriatric Cardiology

Background:

  • Observational data suggest coronary artery bypass graft (CABG) improves outcomes for acute coronary syndromes (ACS) with multivessel coronary artery disease (MV-CAD) compared to percutaneous coronary intervention (PCI) or medical management (MM).
  • Limited research exists on the efficacy of these revascularization strategies in patients aged 75 and older.

Purpose of the Study:

  • To compare the 1-year outcomes of CABG, PCI, and MM in patients with ACS and MV-CAD.
  • To stratify outcomes based on age groups: <75 years and ≥75 years.
  • To evaluate the impact of age on mortality and other clinical endpoints following revascularization.

Main Methods:

  • Retrospective, multi-centered observational study from 2018-2022.
  • Inclusion criteria: patients with ACS and MV-CAD.
  • Primary endpoint: 1-year mortality. Secondary endpoints: readmission, myocardial infarction (MI), length of stay, repeat revascularization. Cox proportional hazards modeling used.

Main Results:

  • A total of 2161 patients were analyzed (1559 CABG, 295 PCI, 307 MM).
  • Patients aged ≥75 (n=614) showed similar outcomes to those <75 (n=1547).
  • CABG was associated with significantly reduced mortality compared to PCI or MM (RR = 0.324, p <0.0001) across both age groups.

Conclusions:

  • Coronary artery bypass graft (CABG) is associated with improved and comparable outcomes in patients with acute coronary syndromes (ACS) and multivessel coronary artery disease (MV-CAD).
  • This benefit extends to patients aged 75 and older, suggesting CABG is a viable revascularization strategy for this demographic.
  • Further research may explore long-term outcomes and quality of life differences between revascularization strategies in elderly populations.

Keywords:
ACSCABGPCIelderlymedical managementmultivessel disease

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