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


METHODS
Individual patient-level meta-analysis.


METHODS
Databases from the BEST, PRECOMBAT, and SYNTAX trials were combined.


METHODS
A total 1,079 adults aged 70 to 89 years were pooled.


METHODS
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.


CONCLUSIONS
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.
Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Korea.
Mineok
M
Chang
Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Cheol Whan
CW
Lee
Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Jung-Min
JM
Ahn
Erasmus University Medical Center, Rotterdam, The Netherlands.
Rafael
R
Cavalcante
Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Yohei
Y
Sotomi
Erasmus University Medical Center, Rotterdam, The Netherlands.
Yoshinobu
Y
Onuma
Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Duk-Woo
DW
Park
Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Soo-Jin
SJ
Kang
Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Seung-Whan
SW
Lee
Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Young-Hak
YH
Kim
Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Seong-Wook
SW
Park
Erasmus University Medical Center, Rotterdam, The Netherlands.|International Center for Circulatory Health, Imperial College of London, London, UK.
Patrick W
PW
Serruys
Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Seung-Jung
SJ
Park
D000368:Aged; D000369:Aged, 80 and over; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000401:mortality / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000453:epidemiology; D063868:Patient Outcome Assessment; D062645:Percutaneous Coronary Intervention; D019233:Retreatment / Q000706:statistics & numerical data; D020521:Stroke / Q000453:epidemiology
coronary artery bypass graft surgery; drug-eluting stents; left main coronary artery disease; multivessel coronary artery disease; older