Outcomes of Coronary Artery Bypass Graft Surgery Versus Drug‐Eluting Stents in Older Adults

Chang, Mineok; Lee, Cheol Whan; Ahn, Jung‐Min; Cavalcante, Rafael; Sotomi, Yohei; Onuma, Yoshinobu; Park, Duk‐Woo; Kang, Soo–Jin; Lee, Seung-Whan; Kim, Young‐Hak; Park, Seong-Wook; Serruys, Patrick W.

doi:10.1111/jgs.14780

Cited by 14 publications

(13 citation statements)

References 22 publications

(65 reference statements)

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“…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 [11].…”

Section: Discussionmentioning

confidence: 97%

MINI OPCAB Mammary to LAD and Optimal Medical Treatment in High Risk Patients with Multivessel Coronary Disease Long Term Results

2021

J Cardiol Clin Pract

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Section: Discussionmentioning

confidence: 97%

MINI OPCAB Mammary to LAD and Optimal Medical Treatment in High Risk Patients with Multivessel Coronary Disease Long Term Results

2021

J Cardiol Clin Pract

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“…An increased rate of myocardial infarctions after PCI was also observed in previous studies in older patients. Older patients aged 70–89 years with LMCA or multivessel CAD who participated in the BEST [18], PRECOMBAT [17], and SYNTAX [19] trials all had reduced rates of the primary composite outcome with CABG, mostly driven by lower risk of myocardial infarction [20]. Although the increased rate of myocardial infarctions after PCI in the group older than 67 years in our study did not translate into differences in all-cause mortality, all reported myocardial infarctions were diagnosed during symptom-driven hospital admissions, indicating a disadvantage for the patient.…”

Section: Discussionmentioning

confidence: 99%

Age-Stratified Outcome in Treatment of Left Main Coronary Artery Stenosis: A NOBLE Trial Substudy

et al. 2021

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Background: In the treatment of left main coronary artery (LMCA) disease, patients’ age may affect the clinical outcome after percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). This study stratified the clinical outcome according to the age of patients treated for LMCA stenosis with PCI or CABG in the Nordic-Baltic-British Left Main Revascularization (NOBLE) study. Methods: Patients with LMCA disease were enrolled in 36 centers in northern Europe and randomized 1:1 to treatment by PCI or CABG. Eligible patients had stable angina pectoris, unstable angina pectoris, or non-ST elevation myocardial infarction. The primary endpoint was major adverse cardiac or cerebrovascular events (MACCEs), a composite of all-cause mortality, nonprocedural myocardial infarction, any repeat coronary revascularization, and stroke. Age-stratified analysis was performed for the groups younger and older than 67 years and for patients older than 80 years. Results: For patients ≥67 years, the 5-year MACCEs were 35.7 versus 22.3% (hazard ratio [HR] 1.72 [95% confidence interval [CI] 1.27–2.33], p = 0.0004) for PCI versus CABG. The difference in MACCEs was driven by more myocardial infarctions (10.8 vs. 3.8% HR 3.01 [95% CI 1.52–5.96], p = 0.0009) and more repeat revascularizations (19.5 vs. 10.0% HR 2.01 [95% CI 1.29–3.12], p = 0.002). In patients younger than 67 years, MACCE was 20.5 versus 15.3% (HR 1.38 [95% CI 0.93–2.06], p = 0.11 for PCI versus CABG. All-cause mortality was similar after PCI and CABG in both age-groups. On multivariate analysis, age was a predictor of MACCE, along with PCI, diabetes, and SYNTAX score. Conclusions: As the overall NOBLE results show revascularization of LMCA disease, age of 67 years or older was associated with lower 5-year MACCE after CABG compared to PCI. Clinical outcomes were not significantly different in the subgroup younger than 67 years, although no significant interaction was present between age and treatment. Mortality was similar for all subgroups (ClinicalTrials.gov identifier: NCT01496651).

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“…However, there have been no randomized trials for comparing the effect of PCI and CABG in very old patients with multivessel disease, such as 3VD. Moreover, results from previous observational studies and pooled-analysis were heterogeneous [ 19 – 22 ]. Therefore, questions persist concerning the optimal treatment strategy of very old patients with 3VD.…”

Section: Discussionmentioning

confidence: 99%

Real-world long-term outcomes based on three therapeutic strategies in very old patients with three-vessel disease

Yuan

Jia

Zhang

et al. 2021

BMC Cardiovasc Disord

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Background There are relatively limited data regarding real-world outcomes in very old patients with three-vessel disease (3VD) receiving different therapeutic strategies. This study aimed to perform analysis of long-term clinical outcomes of medical therapy (MT), coronary artery bypass grafting (CABG), and percutaneous coronary intervention (PCI) in this population. Methods We included 711 patients aged ≥ 75 years from a prospective cohort of patients with 3VD. Consecutive enrollment of these patients began from April 2004 to February 2011 at Fu Wai Hospital. Patients were categorized into three groups (MT, n = 296; CABG, n = 129; PCI, n = 286) on the basis of different treatment strategies. Results During a median follow-up of 7.25 years, 262 deaths and 354 major adverse cardiac and cerebrovascular events (MACCE) occurred. Multivariate Cox analysis showed that the risk of cardiac death was significantly lower for CABG compared with PCI (adjusted hazard ratio [HR] = 0.475, 95% confidence interval [CI] 0.232–0.974, P = 0.042). Additionally, MACCE appeared to show a trend towards a better outcome for CABG (adjusted HR = 0.759, 95% CI 0.536–1.074, P = 0.119). Furthermore, CABG was significantly superior in terms of unplanned revascularization (adjusted HR = 0.279, 95% CI 0.079–0.982, P = 0.047) and myocardial infarction (adjusted HR = 0.196, 95% CI 0.043–0.892, P = 0.035). No significant difference in all-cause death between CABG and PCI was observed. MT had a higher risk of cardiac death than PCI (adjusted HR = 1.636, 95% CI 1.092–2.449, P = 0.017). Subgroup analysis showed that there was a significant interaction between treatment strategy (PCI vs. CABG) and sex for MACCE (P = 0.026), with a lower risk in men for CABG compared with that of PCI, but not in women. Conclusions CABG can be performed with reasonable results in very old patients with 3VD. Sex should be taken into consideration in therapeutic decision-making in this population.

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Outcomes of Coronary Artery Bypass Graft Surgery Versus Drug‐Eluting Stents in Older Adults

Abstract: 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.

Cited by 14 publications

References 22 publications

MINI OPCAB Mammary to LAD and Optimal Medical Treatment in High Risk Patients with Multivessel Coronary Disease Long Term Results

MINI OPCAB Mammary to LAD and Optimal Medical Treatment in High Risk Patients with Multivessel Coronary Disease Long Term Results

Age-Stratified Outcome in Treatment of Left Main Coronary Artery Stenosis: A NOBLE Trial Substudy

Real-world long-term outcomes based on three therapeutic strategies in very old patients with three-vessel disease

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