Key result
Coronary artery bypass graft surgery reduced the risk of major adverse cardio-cerebral events by 25% (HR 0.75) compared to percutaneous coronary intervention with drug-eluting stents in older adults.
Why the study?
Does CABG reduce the composite of death, myocardial infarction, stroke, or repeat revascularization compared to PCI with DES in older adults (70-89 years) with left main or multivessel CAD?
Meta-Analysis (n=1,079)
Open-label
Randomized
Yes
Does CABG reduce the composite of death, myocardial infarction, stroke, or repeat revascularization compared to PCI with DES in older adults (70-89 years) with left main or multivessel CAD?
Hazard Ratio: 0.75 (95% CI 0.6–0.94)
Absolute Event Rate: 25.6% vs 33.8%
p-value: p=0.012
In older adults aged 70 to 89 with left main or multivessel CAD, CABG is associated with a significantly lower risk of major adverse cardiovascular events compared to PCI with DES, primarily driven by reductions in myocardial infarction and repeat revascularization.
Supports CABG over PCI-DES to lower MACE in older adults with left main or multivessel CAD; extends evidence to ages 70-89.
OBJECTIVES: Little data are available to compare coronary artery bypass graft surgery (CABG) vs percutaneous coronary intervention (PCI) with drug-eluting stents (DES) in older adults. We evaluate the long-term outcomes of CABG vs PCI with DES in older adults with left main or multivessel coronary artery disease (CAD). DESIGN: Individual patient-level meta-analysis. SETTINGS: Databases from the BEST, PRECOMBAT, and SYNTAX trials were combined. PARTICIPANTS: A total 1,079 adults aged 70 to 89 years were pooled. MEASUREMENTS: The primary outcome was a composite of death from any causes, myocardial infarction, stroke, or repeat revascularization. RESULTS: During a total of 6.3 (median, 4.9) years of follow-up, the primary composite outcome of all-cause mortality, myocardial infarction, stroke, or repeat revascularization occurred in 26% (141/550) and 34% (179/529) of patients in the CABG and PCI groups, respectively (hazard ratio (HR), 0.75; 95% confidence interval (CI), 0.60-0.94; P = .012). CABG was associated with fewer myocardial infarction (4% vs 8% for PCI; HR, 0.48; 95% CI, 0.29-0.80; P = .037); and repeat revascularizations (8% vs 17% for PCI; HR, 044; 95% CI, 0.31-0.64; P < .001), but had little association with all-cause mortality or stroke. CONCLUSION: Older adults age 70 to 89 years with left main or multivessel CAD who participated in the BEST, PRECOMBAT, and SYNTAX trials; compared to PCI, CABG was associated with lower risk of primary outcome which was mostly driven by lower risk of myocardial infarction.
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Chang et al. (2017) conducted a meta-analysis in Left main or multivessel coronary artery disease (n=1,079). Coronary artery bypass graft surgery (CABG) vs. Percutaneous coronary intervention (PCI) with drug-eluting stents (DES) was evaluated on Composite of death from any causes, myocardial infarction, stroke, or repeat revascularization (HR 0.75, 95% CI 0.60-0.94, p=0.012). Coronary artery bypass graft surgery reduced the risk of major adverse cardio-cerebral events by 25% (HR 0.75) compared to percutaneous coronary intervention with drug-eluting stents in older adults.
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