Comparison of 5-Year Outcomes after Coronary Artery Bypass Grafting and Percutaneous Coronary Intervention in Very Old Patients with Triple-Vessel or Left Main Coronary Artery Disease

Objectives: Little data are available in the comparison of coronary artery bypass grafting (CABG) with percutaneous coronary intervention (PCI) in very old patients with triple-vessel disease (TVD) or left main coronary artery (LMCA) disease. We assessed the clinical effectiveness of CABG in comparison with that of PCI in patients 80 years of age or older with TVD or LMCA disease.

Methods: From the CREDO-Kyoto registry cohort-2, the current study population consisted of 527 patients who were 80 years of age or older and underwent the first coronary revascularization for TVD or LMCA disease. They were divided into two groups, the CABG group (N = 151) and the PCI group (N = 376). The primary outcome measure was all-cause death, and the secondary outcome measures were a composite of cardiac death or myocardial infarction (MI), cardiac death, noncardiac death, MI, stroke, hospitalization for heart failure, major bleeding after 30 days, and any coronary revascularization.

Results: The median and interquartile range of patient’s age were 82 (81–84) in the CABG group and 83 (81–85) in the PCI group (p = 0.10). Additionally, patients 85 years of age or older accounted for 19% in the CABG group and 31% in the PCI group (p < 0.01). The cumulative 5-year incidence of all-cause death was not different between the CABG and the PCI groups (35.8 vs. 42.9%, log-lank p = 0.18). However, after adjusting for 22 clinically relevant factors, the lower risk of CABG relative to PCI for all-cause death turned significant (hazard ratio [HR]: 0.61, 95% confidence interval [CI] 0.43–0.86, p = 0.005). The cumulative 5-year incidence of a composite of cardiac death and MI was significantly different between the two groups (21.7 vs. 33.9%, log-lank p = 0.005). The lower risk of CABG relative to PCI for a composite of cardiac death or MI remained significant (HR: 0.52, 95% CI: 0.32–0.85, p = 0.009).

Conclusion: CABG was associated with a significantly lower 5-year mortality rate in patients of ≥80 years of age with TVD or LMCA disease in comparison to PCI. CABG seemed an acceptable option for even very old patients with severe coronary artery disease.