Published in:
01-05-2022 | Arterial Diseases | Original Article
Five-year outcomes after coronary artery bypass grafting and percutaneous coronary intervention in octogenarians with complex coronary artery disease
Published in: General Thoracic and Cardiovascular Surgery | Issue 5/2022
Login to get accessAbstract
Objective
We assessed the clinical effectiveness of coronary artery bypass grafting (CABG) in comparison with that of percutaneous coronary intervention (PCI) in octogenarians with triple-vessel disease (TVD) or left main coronary artery (LMCA) disease.
Methods
From the CREDO-Kyoto registry cohort-2, 527 patients, who were ≥ 80 years of age and underwent the first coronary revascularization for TVD or LMCA disease, were divided into the CABG group (N = 151) and the PCI group (N = 376).
Results
The median and interquartile range of patient’s age was 82 (81–84) in the CABG group and 83 (81–85) in the PCI group (P = 0.10). Patients > = 85 years of age accounted for 19% and 31% in the CABG and PCI groups, respectively (P = 0.01).
The cumulative 5-year incidence of all-cause death was similar between CABG and PCI groups (35.8% vs. 42.9%, log-rank P = 0.18), while CABG showed a lower rate of the composite of cardiac death/MI than PCI (21.7% vs. 33.9%, log-rank P = 0.005). After adjusting for confounders, the lower risk of CABG relative to PCI was significant for all-cause death (HR 0.61, 95% CI 0.43–0.86, P = 0.005), any coronary revascularization (HR 0.25, 95% CI 0.14–0.43, P < 0.001) and the composite of cardiac death/MI (HR 0.52, 95% CI 0.32–0.85, P = 0.009).
Conclusions
CABG compared with PCI was associated with a lower adjusted risk for all-cause death, any coronary revascularization, and a composite of cardiac death/MI in very elderly patients with TVD or LMCA disease. CABG seemed an acceptable option for selected octogenarians with severe coronary artery disease.