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.

中文翻译：

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八十多岁复杂冠状动脉疾病患者冠状动脉旁路移植术和经皮冠状动脉介入治疗后的五年结果

客观的

我们评估了冠状动脉旁路移植术 (CABG) 与经皮冠状动脉介入治疗 (PCI) 在患有三支血管疾病 (TVD) 或左主干冠状动脉 (LMCA) 疾病的八十多岁老人中的临床疗效。

方法

从 CREDO-Kyoto 注册队列 2 中，527 名年龄≥80 岁且因 TVD 或 LMCA 疾病接受了首次冠状动脉血运重建的患者分为 CABG 组（N  = 151）和 PCI 组（N  = 376）。

结果

CABG 组和 PCI 组患者年龄的中位数和四分位间距分别为 82 岁（81-84 岁）和 83 岁（81-85 岁）（P  = 0.10）。CABG 组和 PCI 组中 > = 85 岁的患者分别占 19% 和 31% ( P  = 0.01)。

CABG 组和 PCI 组的 5 年累积全因死亡发生率相似（35.8% 对 42.9%，对数秩P  = 0.18），而 CABG 显示心脏死亡/MI 的复合发生率低于 PCI （21.7% 对 33.9%，对数秩P  = 0.005）。在调整混杂因素后，CABG 相对于 PCI 的较低风险对于全因死亡（HR 0.61, 95% CI 0.43–0.86, P  = 0.005）、任何冠状动脉血运重建（HR 0.25, 95% CI 0.14–0.43, P  < 0.001）和心源性死亡/心肌梗死的复合（HR 0.52, 95% CI 0.32–0.85, P  = 0.009）。

结论

与 PCI 相比，CABG 与 TVD 或 LMCA 疾病的非常老年患者的全因死亡、任何冠状动脉血运重建以及心源性死亡/MI 的复合风险较低相关。对于患有严重冠状动脉疾病的特定八十多岁老人，CABG 似乎是一个可以接受的选择。