Similar Safety Outcomes with CABG, DES in Elderly Patients

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Intermediate-term outcomes after coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are similar in patients 75 and older, according to a study published online December 16, 2013, ahead of print in the American Journal of Cardiology. However, PCI is associated with a higher risk of repeat revascularization. 

Edward L. Hannan, PhD, of the State University of New York at Albany (Albany, NY), and colleagues conducted a propensity-matched analysis of 1,932 patient pairs aged at least 75 years with multivessel disease who underwent CABG or PCI with DES from 2008-2010. Patient data were taken from 59 hospitals enrolled in New York State’s clinical registries for each procedure.

After a mean follow-up time of 1.5 years, there were no differences in mortality or the composite endpoint of stroke, MI, and mortality between the treatment groups. However, those who received PCI reported higher rates of repeat revascularization (table 1).

Table 1. Kaplan-Meier Clinical Outcome Estimates at 2.5 Years

 

CABG
(n = 1,932)

PCI
(n = 1,932)

Adjusted HR (95% CI)

PValue

Mortality

15.8%

16.9%

1.06 (0.87-1.30)

0.58

Stroke, MI, and Mortality

19.8%

21.9%

1.15 (0.97-1.38)

0.12

Repeat Revascularization

4.5%

24.1%

7.48 (5.61-9.98)

< 0.0001

 

Subgroup analysis of high-risk patients (low EF, COPD, diabetes, and proximal LAD disease), showed no differences in mortality between CABG and PCI. However, patients without COPD had a lower incidence of stroke, MI, and mortality when treated with CABG compared with PCI. CABG was also associated with lower rates of repeat revascularization for all patient subgroups.

Continuous Updates Necessary

Although numerous studies comparing CABG and PCI have been conducted, most of them neglect elderly patients, Dr. Hannan and colleagues write. There also 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,” they say.

The authors acknowledge the limited power to draw conclusions on the high-risk subgroups given the small sample size of the study. Another “caveat of our study is the selection bias introduced by not randomizing patients to the two treatments,” and the fact that procedures were only limited to those performed in New York State, they note.

 


Source:
Hannan EL, Zhong Y, Berger PB, et al. Comparison of intermediate term outcomes for coronary artery bypass grafting versus drug-eluting stents for patients ≥ 75 years of age. Am J Cardiol. 2013;Epub ahead of print.

 

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Disclosures
  • There is no statement regarding conflicts of interest for Dr. Hannan.

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