For elderly patients with complex CAD, PCI and CABG lead to comparable long-term outcomes
Percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) are associated with similar outcomes among elderly patients with complex coronary artery disease (CAD), according to a new analysis published in the Journal of the American College of Cardiology.
The study represents an update of the SYNTAX trial, which originally compared PCI and CABG in patients with three-vessel disease (3VD) and/or left main coronary artery disease (LMCAD). For this latest look at the SYNTAX numbers, researchers examined five- and 10-year outcomes to track how the revascularization modality of choice may impact patient care. The group focused specifically on outcomes among elderly patients, defined as any individual over the age of 70 at the time of treatment.
“Current guidelines do not provide sufficient evidence-based recommendations for the management of elderly patients with complex CAD such as 3VD or LMCAD,” wrote lead author Masafumi Ono, MD, a cardiologist at the University of Amsterdam in the Netherlands, and colleagues. “Older patients are frequently more frail than younger patients, and consequently practitioners may be reluctant to recommend an invasive surgical strategy to treat their complex CAD. Although risk models incorporating age and patient comorbidities are advocated to quantify overall risk, and may assist the heart team in deciding the most appropriate revascularization strategy, these models were developed from studies including mainly younger patients.”
Ono et al. tracked 1,800 patients with 3VD and/or LMD from the SYNTAX trial. All patients were treated in one of 85 hospitals throughout North American and Europe. Approximately half underwent PCI and the other half underwent CABG. Nearly 32% of patients were elderly, defined in this analysis as being over the age of 70.
Overall, 10-year mortality was 44.1% for elderly PCI patients and 41.1% for elderly CABG patients, a difference that was not seen as significant. Among patients 70 years or younger, meanwhile, 10-year mortality was 21.1% for PCI patients and 16.6% for CABG patients—again, an insignificant difference between the two groups.
The major adverse cardiac or cerebrovascular event (MACCE) rate after five years was also similar between elderly PCI (39.4%) and elderly CABG (35.1%) patients. The authors did observe, however, that the five-year MACCE rate was significantly higher for younger PCI patients (36.3%) than the younger CABG patients (23%).
Life expectancy and 5-year quality of life (QOL) status were both also similar between PCI and CABG patients. This finding, the authors wrote, suggests that “a less invasive strategy using PCI instead of CABG may be favored for elderly patients, and actually preferred by them.”
“Although the final treatment decision should be selected on an individual basis integrating all the factors, including life expectancy and QOL, PCI might be a reasonable alternative to CABG for elderly patients with 3VD and/or LMCAD,” the group concluded.
The full study is available here.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.