title: Long-term Outcome after Percutaneous Coronary Intervention Compared with Minimally Invasive Coronary Artery Bypass Surgery in the Elderly.
abstract: BACKGROUND
  Elderly patients with unstable coronary artery disease (CAD) have better outcomes with coronary revascularization than conservative treatment. With the improvement in percutaneous coronary intervention (PCI) techniques using drug eluting-stents, this became an attractive option in elderly. Minimally invasive coronary artery bypass grafting (MICS-CABG) is a safe and effective alternative to conventional CABG. We aimed to explore the long-term outcomes after PCI vs MICS-CABG in ≥75 year-old patients with severe CAD.
  
  
  METHODS
  A total of 1454 elderly patients (≥75 year-old patients) underwent coronary artery revascularization between January 2005 and December 2009. Patients were selected in the study if they have one of the Class-I indications for CABG. Groups were divided according to the type of procedure, PCI or MICS-CABG, and 5 year follow-up.
  
  
  RESULTS
  Among 175 elderly patients, 109 underwent PCI and 66 had MICS-CABG. There was no significant difference observed in both groups with long-term all-cause mortality (31 PCI vs 21% MICS-CABG, p=0.151) and the overall 5 year survival was similar on Kaplan-Meier curve (Log rank p=0.318). The average length of stay in hospital was significantly shorter in the PCI than in the MICS-CABG group (4.3 vs 7.8 days, p<0.001). Only 4.7% of the PCI group were discharged to rehabilitation facility compared with 43.9% of the MICS-CABG group (p<0.001). The rate of repeat revascularization was significantly higher in the PCI group than in the MICS-CABG group (15 vs 3%, p=0.014).
  
  
  CONCLUSIONS
  Among elderly patients, long-term all-cause mortality is similar after PCI and MICS-CABG. However, there is a significantly higher rate of repeat revascularization after PCI.
authors.affiliation: Department of Medicine, Staten Island University Hospital, North Shore-LIJ Health System, Staten Island, New York, USA.
authors.forename: Emad A
authors.initials: EA
authors.lastname: Barsoum
authors.affiliation: Department of General Surgery, Staten Island University Hospital, North Shore-LIJ Health System, Staten Island, New York, USA.
authors.forename: Basem
authors.initials: B
authors.lastname: Azab
authors.affiliation: Department of Medicine, Staten Island University Hospital, North Shore-LIJ Health System, Staten Island, New York, USA.
authors.forename: Nileshkumar
authors.initials: N
authors.lastname: Patel
authors.affiliation: Department of Medicine, Staten Island University Hospital, North Shore-LIJ Health System, Staten Island, New York, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Spagnola
authors.affiliation: Department of Cardiothoracic Surgery, Staten Island University Hospital, North Shore-LIJ Health System, Staten Island, New York, USA.
authors.forename: Masood A
authors.initials: MA
authors.lastname: Shariff
authors.affiliation: Department of Medicine, Staten Island University Hospital, North Shore-LIJ Health System, Staten Island, New York, USA.
authors.forename: Umar
authors.initials: U
authors.lastname: Kaleem
authors.affiliation: Department of Medicine, Staten Island University Hospital, North Shore-LIJ Health System, Staten Island, New York, USA.
authors.forename: Rewais
authors.initials: R
authors.lastname: Morcus
authors.affiliation: Department of Cardiology, Staten Island University Hospital, North Shore-LIJ Health System, Staten Island, New York, USA.
authors.forename: Deepak
authors.initials: D
authors.lastname: Asti
authors.affiliation: Department of General Surgery, Staten Island University Hospital, North Shore-LIJ Health System, Staten Island, New York, USA; Department of Cardiothoracic Surgery, Staten Island University Hospital, North Shore-LIJ Health System, Staten Island, New York, USA.
authors.forename: Joseph T
authors.initials: JT
authors.lastname: McGinn
authors.affiliation: Department of Cardiology, Staten Island University Hospital, North Shore-LIJ Health System, Staten Island, New York, USA.
authors.forename: James
authors.initials: J
authors.lastname: Lafferty
authors.affiliation: Department of Cardiology, Staten Island University Hospital, North Shore-LIJ Health System, Staten Island, New York, USA.
authors.forename: Donald A
authors.initials: DA
authors.lastname: McCord
keywords: Coronary artery disease; Elderly; MICS-CABG; PCI