Coronary Artery DiseaseComparison of Intermediate-Term Outcomes of Coronary Artery Bypass Grafting Versus Drug-Eluting Stents for Patients ≥75 Years of Age
Section snippets
Methods
End points in the study included 2.5-year mortality, stroke/myocardial infarction (MI)/mortality, and repeat revascularization. The mean follow-up time was 1.5 years; all procedures performed from January 1, 2008 to December 31, 2010 were followed through December 31, 2010.
The primary databases used for the study were New York State's clinical registries for PCI and for CABG, the Percutaneous Coronary Interventions Reporting System (PCIRS) and the Cardiac Surgery Reporting System (CSRS),
Results
A total of 6,927 patients aged ≥75 years (4,299 patients who received DES and 2,628 CABG) were subjected to propensity matching and 3,864 patients (1,932 pairs and 74% of all patients receiving CABG) were propensity matched. The variables used in the propensity model are all the variables in Table 1, and the C statistic for the models was 0.81.
Table 1 presents differences in patient characteristics for patients receiving DES and CABG in New York from 2008 to 2010. As indicated, older patients,
Discussion
Numerous comparative effectiveness studies have been conducted to compare outcomes of CABG and PCI with stents for patients with multivessel coronary artery disease.6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20 However, there is a need to continually update studies of this nature because of the evolution of the 2 procedures, particularly PCI, which has evolved from balloon angioplasty to bare-metal stenting to multiple generations of DES.
In 2009, Hlatky et al9 pooled data from 10
Acknowledgment
The authors thank New York State's Cardiac Advisory Committee (CAC) for their encouragement and support of this study and Kimberly S. Cozzens, MA and Cynthia Johnson and the cardiac catheterization laboratories of the participating hospitals for their tireless efforts to ensure the timeliness, completeness, and accuracy of the registry data.
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Cited by (29)
Invasively managed acute coronary syndrome in octogenarian patients: a retrospective cohort study
2023, REC: CardioClinicsCitation Excerpt :Several studies have compared revascularisation outcomes with either PCI or CABG obtaining conflicting results. Whereas a meta-analysis of 66 studies observed that CABG was associated with higher 30-day and 1-year mortality rates,20 other series have described poorer short and long-term outcomes with PCI21,22 with other studies reporting no significant differences between both techniques with regards to all-cause death, myocardial infarction, and stroke.23 Although CABG more frequently achieves complete revascularisation compared to PCI, with a lower requirement for repeat revascularisation, the less invasive PCI approach may be more appropriate in older patients who are often frail and are more prone to periprocedural CABG complications, including stroke and neurocognitive decline.18
Revascularization Strategies for Multivessel Coronary Artery Disease in the Elderly Population
2022, Journal of Surgical ResearchCitation Excerpt :The authors did find increased hazards for mortality with PCI with BMS in comparison to CABG (adjusted HR 1.54, 95% CI: 1.07-2.22), but did not find difference in mortality between PCI with DES and CABG (adjusted HR 1.15, 95% CI: 0.82-1.60). Similarly in a propensity-matched observational study by Hannan, matched pairs of patients receiving PCI with DES and CABG did not demonstrate difference in mortality, but a higher rate of repeated revascularization following PCI.20 Not surprisingly, our study did find favorable short-term outcomes such as reduced hospital length of stay and higher likelihood of discharge to home following PCI procedures, though, 30d mortality was similar.
Which elderly with stable angina should be referred for cardiac surgery?
2018, Annales de Cardiologie et d'AngeiologieCoronary Artery Disease in Patients ≥80 Years of Age
2018, Journal of the American College of CardiologyRevascularization Strategies and Outcomes in Elderly Patients With Multivessel Coronary Disease
2017, Annals of Thoracic SurgeryCitation Excerpt :At a mean follow-up of 18 months, they found no difference in mortality (HR 1.06, 95% CI: 0.87 to 1.30, p = 0.58) or combined stroke, MI, and mortality (HR 1.15, 95% CI: 0.97 to 1.38, p = 0.12); however, there was a significant difference in revascularization associated with CABG (DES versus CABG HR 7.48, 95% CI: 5.61 to 9.98, p < 0.0001). The lack of mortality difference between CABG and DES demonstrated by Hannan and colleagues [19] mirrors the results of our analysis. Although CABG is associated with a reduction in combined cardiovascular endpoints, there may not be an associated mortality benefit in the elderly when compared with newer generation DES.
Considerations in Cardiac Revascularization for the Elderly Patient: Age Isn't Everything
2016, Canadian Journal of Cardiology
This work was supported by grant RC1HL099122 from the National Institutes of Health, Bethesda, Maryland.
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