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

  • Autores: Mineok Chang, Cheol Whan Lee, Jung-Min Ahn-, Rafael de Oliveira Cavalcante, Yohei Sotomi, Yoshinobu Onuma, Duk-Woo Park, Patrick W. Serruys, Seung-Jung Park
  • Localización: Journal of the American Geriatrics Society, ISSN 0002-8614, Vol. 65, Nº. 3, 2017, págs. 625-630
  • Idioma: inglés
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  • Resumen
    • 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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