Comparison of Intermediate-Term Outcomes of Coronary Artery Bypass Grafting Versus Drug-Eluting Stents for Patients ≥75 Years of Age

Several randomized controlled trials and observational studies have compared outcomes of percutaneous coronary interventions (PCIs) with drug-eluting stents (DESs) and coronary artery bypass grafting (CABG), but they have not thoroughly investigated the relative difference in outcomes for patients a...

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Bibliographic Details
Published in:The American journal of cardiology 2014-03, Vol.113 (5), p.803-808
Main Authors: Hannan, Edward L., PhD, Zhong, Ye, MD, MS, Berger, Peter B., MD, Walford, Gary, MD, Curtis, Jeptha P., MD, Wu, Chuntao, MD, Venditti, Ferdinand J., MD, Higgins, Robert S.D., MD, Smith, Craig R., MD, Lahey, Stephen J., MD, King, Spencer B., MD
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Cardiovascular
Cardiovascular disease
Chronic obstructive pulmonary disease
Comorbidity
Comparative Effectiveness Research
Coronary Artery Bypass
Coronary Artery Disease - blood
Coronary Artery Disease - epidemiology
Coronary Artery Disease - mortality
Coronary Artery Disease - surgery
Coronary Artery Disease - therapy
Coronary Stenosis - epidemiology
Coronary vessels
Creatinine - blood
Diabetes
Diabetic Angiopathies - surgery
Diabetic Angiopathies - therapy
Drug-Eluting Stents
Female
Heart attacks
Heart surgery
Humans
Kaplan-Meier Estimate
Male
Mortality
Percutaneous Coronary Intervention
Propensity Score
Pulmonary Disease, Chronic Obstructive - epidemiology
Registries
Retreatment
Risk Factors
Stents
Stroke
Studies
Treatment Outcome
Utilization review
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Summary:Several randomized controlled trials and observational studies have compared outcomes of percutaneous coronary interventions (PCIs) with drug-eluting stents (DESs) and coronary artery bypass grafting (CABG), but they have not thoroughly investigated the relative difference in outcomes for patients aged ≥75 years. In this study, a total of 3,864 patients receiving DES and CABG (1,932 CABG-DES pairs) with multivessel coronary disease were propensity matched using multiple patient risk factors and were compared with respect to 3 outcomes (mortality, stroke/myocardial infarction [MI]/mortality, and repeat revascularization) at 2.5 years with a mean follow-up of 18 months. The mortality rates (DES/CABG hazard ratio 1.06, 95% confidence interval 0.87 to 1.30) and the stroke/MI/mortality rates (DES/CABG hazard ratio 1.15, 95% confidence interval 0.97 to 1.38) for the 2 procedures were not significantly different. Repeat revascularization rates were significantly higher for patients who received DESs. In conclusion, older patients experienced similar mortality and stroke/MI/mortality rates for CABG and PCI with DES, although repeat revascularization rates were higher for patients undergoing PCI with DES.
ISSN:0002-9149
1879-1913
DOI:10.1016/j.amjcard.2013.11.035