Key result
In elderly patients with severe coronary artery disease, percutaneous coronary intervention resulted in similar long-term all-cause mortality compared to minimally invasive coronary artery bypass surgery (31% vs 21%, p=0.151).
Why the study?
Does percutaneous coronary intervention reduce long-term all-cause mortality compared to minimally invasive coronary artery bypass grafting in elderly patients (≥75 years) with severe CAD?
Cohort (n=175)
No
Does percutaneous coronary intervention reduce long-term all-cause mortality compared to minimally invasive coronary artery bypass grafting in elderly patients (≥75 years) with severe CAD?
Absolute Event Rate: 31% vs 21%
p-value: p=0.151
In elderly patients with severe CAD, PCI and MICS-CABG offer similar long-term survival, though PCI is associated with shorter hospital stays but higher rates of repeat revascularization.
Should not yet change revascularization choices in elderly severe CAD; leaves open need for randomized confirmation of similar survival.
BACKGROUND: Elderly patients with unstable coronary artery disease (CAD) have better outcomes with coronary revascularization than conservative treatment. With the improvement in percutaneous coronary intervention (PCI) techniques using drug eluting-stents, this became an attractive option in elderly. Minimally invasive coronary artery bypass grafting (MICS-CABG) is a safe and effective alternative to conventional CABG. We aimed to explore the long-term outcomes after PCI vs MICS-CABG in ≥75 year-old patients with severe CAD. METHODS: A total of 1454 elderly patients (≥75 year-old patients) underwent coronary artery revascularization between January 2005 and December 2009. Patients were selected in the study if they have one of the Class-I indications for CABG. Groups were divided according to the type of procedure, PCI or MICS-CABG, and 5 year follow-up. RESULTS: Among 175 elderly patients, 109 underwent PCI and 66 had MICS-CABG. There was no significant difference observed in both groups with long-term all-cause mortality (31 PCI vs 21% MICS-CABG, p=0.151) and the overall 5 year survival was similar on Kaplan-Meier curve (Log rank p=0.318). The average length of stay in hospital was significantly shorter in the PCI than in the MICS-CABG group (4.3 vs 7.8 days, p<0.001). Only 4.7% of the PCI group were discharged to rehabilitation facility compared with 43.9% of the MICS-CABG group (p<0.001). The rate of repeat revascularization was significantly higher in the PCI group than in the MICS-CABG group (15 vs 3%, p=0.014). CONCLUSION: Among elderly patients, long-term all-cause mortality is similar after PCI and MICS-CABG. However, there is a significantly higher rate of repeat revascularization after PCI.
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Barsoum et al. (2016) conducted a cohort in Severe coronary artery disease (n=175). Percutaneous Coronary Intervention (PCI) vs. Minimally Invasive Coronary Artery Bypass Surgery (MICS-CABG) was evaluated on Long-term all-cause mortality (p=0.151). In elderly patients with severe coronary artery disease, percutaneous coronary intervention resulted in similar long-term all-cause mortality compared to minimally invasive coronary artery bypass surgery (31% vs 21%, p=0.151).
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