title: Comparison by meta-analysis of percutaneous coronary intervention versus coronary artery bypass grafting in patients with a mean age of ≥70 years.
abstract: A paucity of published data evaluating the outcomes of older patients (age ≥70 years) undergoing revascularization for unprotected left main coronary artery disease is available. We performed aggregate data meta-analyses of the clinical outcomes (all-cause mortality, nonfatal myocardial infarction, stroke, repeat revascularization, and major adverse cardiac and cerebrovascular events at 30 days and 12 and 22 months) in studies comparing percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in patients with a mean age of ≥70 years and unprotected left main coronary artery disease. A comprehensive, time-unlimited literature search to January 31, 2013 identified 10 studies with a total of 2,386 patients (PCI, n = 909; CABG, n = 1,477). Summary odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using the random-effects model. The patients in the PCI group were more likely than those in the CABG group to present with acute coronary syndrome (59.6% vs 44.8%, p <0.001). PCI was associated with a shorter hospital stay (4.2 ± 0.8 vs 8.3 ± 0.01 days, p <0.001). No significant differences were found between PCI and CABG for all cause-mortality, nonfatal myocardial infarction, and major adverse cardiac and cerebrovascular events at 30 days and 12 and 22 months. However, PCI was associated with lower rates of stroke at 30 days (OR 0.14, 95% CI 0.02 to 0.76) and 12 months (OR 0.14, 95% CI 0.03 to 0.60) and higher rates of repeat revascularization at 22 months (OR 4.34, 95% CI 2.69 to 7.01). These findings were consistent with the findings from a subgroup analysis of patients aged ≥75 years. In conclusion, older patients (age ≥70 years) with unprotected left main coronary artery disease had comparable rates of all-cause mortality, nonfatal myocardial infarction, and major adverse cardiac and cerebrovascular events after PCI or CABG. The patients undergoing PCI had a shorter hospital stay and lower rates of early stroke; however, they experienced higher repeat revascularization rates at longer term follow-up.
authors.affiliation: Baylor College of Medicine, Houston, TX, USA. malam@bcm.tmc.edu
authors.forename: Mahboob
authors.initials: M
authors.lastname: Alam
authors.forename: Salim S
authors.initials: SS
authors.lastname: Virani
authors.forename: Saima A
authors.initials: SA
authors.lastname: Shahzad
authors.forename: Sahar
authors.initials: S
authors.lastname: Siddiqui
authors.forename: Khaleeq H
authors.initials: KH
authors.lastname: Siddiqui
authors.forename: Shahzad A
authors.initials: SA
authors.lastname: Mumtaz
authors.forename: Neal S
authors.initials: NS
authors.lastname: Kleiman
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Coselli
authors.forename: Nasser M
authors.initials: NM
authors.lastname: Lakkis
authors.forename: Hani
authors.initials: H
authors.lastname: Jneid
mesh_terms: D054058:Acute Coronary Syndrome / Q000209:etiology* / Q000628:therapy; D000368:Aged; D000369:Aged, 80 and over; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000150:complications / Q000401:mortality / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009203:Myocardial Infarction / Q000517:prevention & control; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention; D020521:Stroke / Q000517:prevention & control; D016896:Treatment Outcome