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Five-year outcomes after coronary artery bypass grafting and percutaneous coronary intervention in octogenarians with complex coronary artery disease

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Abstract

Objective

We assessed the clinical effectiveness of coronary artery bypass grafting (CABG) in comparison with that of percutaneous coronary intervention (PCI) in octogenarians with triple-vessel disease (TVD) or left main coronary artery (LMCA) disease.

Methods

From the CREDO-Kyoto registry cohort-2, 527 patients, who were ≥ 80 years of age and underwent the first coronary revascularization for TVD or LMCA disease, were divided into the CABG group (N = 151) and the PCI group (N = 376).

Results

The median and interquartile range of patient’s age was 82 (81–84) in the CABG group and 83 (81–85) in the PCI group (P = 0.10). Patients >  = 85 years of age accounted for 19% and 31% in the CABG and PCI groups, respectively (P = 0.01).

The cumulative 5-year incidence of all-cause death was similar between CABG and PCI groups (35.8% vs. 42.9%, log-rank P = 0.18), while CABG showed a lower rate of the composite of cardiac death/MI than PCI (21.7% vs. 33.9%, log-rank P = 0.005). After adjusting for confounders, the lower risk of CABG relative to PCI was significant for all-cause death (HR 0.61, 95% CI 0.43–0.86, P = 0.005), any coronary revascularization (HR 0.25, 95% CI 0.14–0.43, P < 0.001) and the composite of cardiac death/MI (HR 0.52, 95% CI 0.32–0.85, P = 0.009).

Conclusions

CABG compared with PCI was associated with a lower adjusted risk for all-cause death, any coronary revascularization, and a composite of cardiac death/MI in very elderly patients with TVD or LMCA disease. CABG seemed an acceptable option for selected octogenarians with severe coronary artery disease.

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Acknowledgements

We appreciate the collaboration of the co-investigators in the CREDO-Kyoto PCI/CABG Registry Cohort-2.

Funding

This study was supported by the Pharmaceuticals and Medical Devices Agency, Tokyo, Japan.

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Correspondence to Takeshi Kimura.

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The authors have nothing to disclose concerning the current study.

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Hara, H., Watanabe, H., Esaki, J. et al. Five-year outcomes after coronary artery bypass grafting and percutaneous coronary intervention in octogenarians with complex coronary artery disease. Gen Thorac Cardiovasc Surg 70, 419–429 (2022). https://doi.org/10.1007/s11748-021-01711-4

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