P revious randomized, controlled trials (RCTs) comparing percutaneous coronary intervention (PCI) with coronary artery bypass grafting (CABG) in the era of balloon angioplasty and bare metal stents (BMS) have generally suggested similar long-term survival up to 5 years in patients with multivessel coronary artery disease (CAD). [1][2][3][4][5][6][7][8][9] However, the subsequent trials in the era of drug-eluting stents (DES), in which mostly high-risk patients with diabetes mellitus or triple-vessel CAD were enrolled, have demonstrated significantly lower mortality after CABG compared with PCI. [10][11][12][13] We also have reported the better long-term outcomes in terms of all-cause death and myocardial infarction (MI) after CABG than after PCI in the all-comer CREDO-Kyoto (Coronary Revascularization Demonstrating Outcome Study in Kyoto) registry Cohort-1 and Cohort-2 in the era of BMS and DES, respectively.
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Clinical Perspective on p 1891Among those factors influencing the decision making on the choice of coronary revascularization strategies (PCI/ Background-Age and sex are important considerations in the choice between percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in daily clinical practice.
Methods and Results-Of 25 816 patients enrolled in the multicenter Coronary Revascularization Demonstrating OutcomeStudy in Kyoto (CREDO-Kyoto; Cohort-1, n=9877; Cohort-2, n=15 939), the present study population consisted of 5651 patients (men, n=3998; women, n=1653) with triple-vessel coronary artery disease who were considered to be pertinent in comparisons of PCI with CABG (PCI, n=3165; CABG, n=2486). Patients were divided into 3 groups according to the tertiles of age: ≤65 years (n=1972), 66 to 73 years (n=1820), and ≥74 years (n=1859). The excess adjusted mortality risk of PCI relative to CABG was significant in patients ≥74 years of age (hazard ratio [HR], 1.40; 95% confidence interval [CI], 1.10-1.79; P=0.006), whereas the risks were neutral in patients ≤65 years of age (HR, 1.05; 95% CI, 0.73-1.53; P=0.78) and in patients 66 to 73 years of age (HR, 1.03; 95% CI, 0.78-1.36; P=0.85; interaction P=0.003). The excess mortality risk of PCI relative to CABG was significant in men (HR, 1.24; 95% CI, 1.03-1.50; P=0.02) and trended to be significant in women (HR, 1.34; 95% CI, 0.98-1.84; P=0.07) without significant interaction between sex and the mortality risk of PCI relative to CABG (interaction P=0.40). Conclusions-There was a significant association between age and the mortality risk of PCI relative to CABG with excess risk in patients ≥74 years of age and neutral risk in younger patients. There was no significant sex-related difference in the mortality risk of PCI relative to CABG. Correspondence to Takeshi Kimura, MD, Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507 Japan. E-mail taketaka@kuhp.kyoto-ua.ac.jp superelder patients. Furthermore, the 10 RCTs included in the pooled analysis...