Long-term follow-up after bypass surgery or coronary stenting in elderly with multivessel disease

Abstract

Background We sought to compare long-term followup of coronary artery bypass grafting (CABG) with percutaneous coronary intervention (PCI) in elderly patients with left main or multivessel disease, hypothesising that completeness of revascularisation and severity of coronary artery disease are predictors of adverse outcomes. Methods Patients aged ≥75 years with multivessel disease or left main disease who underwent PCI or CABG between 2012-2016 were included in this retrospective cohort study. Baseline characteristics from the index procedure were collected. Severity of coronary artery disease and completeness of revascularisation were assessed. Primary outcome was all-cause mortality, in addition we captured major adverse cardiac and cerebral events, bleedings, recurrent angina and new onset atrial fibrillation. Results A total of 597 patients were included. Median follow-up was 4 years (interquartile range 2.8-5.3 years). At baseline, patients in the PCI group more often had a previous medical history of CABG and more frequently underwent an urgent procedure compared with patients in the CABG group. Mortality at 5-year follow-up was significantly higher in patients who underwent PCI compared with CABG (39.9% vs 25.4%, p < 0.001). Furthermore, acute coronary syndrome (ACS), repeat revascularisation and recurrent angina occurred more frequently after PCI, while occurrence of bleedings and new onset atrial fibrillation were

Long-term effects of percutaneous coronary intervention versus coronary artery surgery in elderly with multi-vessel coronary artery disease

“…The intraprocedural complications in the angiography were only in 2% of cases. These findings were comparable with the published trials, where the mean number of stents used in BEST trial [9], Freedom follow on study [10], and Gimbel et al [11] study were 3.4, 3.4, and 1.71, respectively.…”

Myocardial revascularization by percutaneous coronary intervention in senile patients with chronic total occlusion: a modern view of the problem

“…Среди пациентов с трехсосудистым поражением 153 (28%) из 546 умерли после ЧКВ, а 114 (21%) из 549 после КШ. Через 10 лет не было существенной разницы в смерти между ЧКВ и КШ, но КШ обеспечило определенный выигрыш в выживаемости у пациентов с трехсосудистыми поражениями [20,21]. Этот вывод подтверждается и в исследовании 2019г EXEL.…”

Coronary stenting versus bypass surgery in elderly with multivessel disease: long-term mortality rate is still up for debate

“…Based on their long-term follow-up study in elderly patients with multivessel disease, Gimbel et al. reported a significantly higher 5‑year mortality after percutaneous coronary intervention (PCI) compared with coronary artery bypass grafting (CABG) in a recent issue of the Netherlands Heart Journal [ 1 ]. In addition, completeness of revascularisation appeared not to be an independent predictor of adverse outcomes in this patient population [ 1 ].…”

“…reported a significantly higher 5‑year mortality after percutaneous coronary intervention (PCI) compared with coronary artery bypass grafting (CABG) in a recent issue of the Netherlands Heart Journal [ 1 ]. In addition, completeness of revascularisation appeared not to be an independent predictor of adverse outcomes in this patient population [ 1 ]. We wish to highlight a few factors that require clarification and may influence the differences observed between the study groups.…”