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. 2016 Feb 8:10:11-8.
doi: 10.2174/1874192401610010011. eCollection 2016.

Long-term Outcome after Percutaneous Coronary Intervention Compared with Minimally Invasive Coronary Artery Bypass Surgery in the Elderly

Emad A Barsoum  1 , Basem Azab  2 , Nileshkumar Patel  1 , Jonathan Spagnola  1 , Masood A Shariff  3 , Umar Kaleem  1 , Rewais Morcus  1 , Deepak Asti  4 , Joseph T McGinn Jr  5 , James Lafferty  4 , Donald A McCord  4
Affiliations

Long-term Outcome after Percutaneous Coronary Intervention Compared with Minimally Invasive Coronary Artery Bypass Surgery in the Elderly

Emad A Barsoum et al. Open Cardiovasc Med J. .

Abstract

Background: Elderly patients with unstable coronary artery disease (CAD) have better outcomes with coronary revascularization than conservative treatment. With the improvement in percutaneous coronary intervention (PCI) techniques using drug eluting-stents, this became an attractive option in elderly. Minimally invasive coronary artery bypass grafting (MICS-CABG) is a safe and effective alternative to conventional CABG. We aimed to explore the long-term outcomes after PCI vs MICS-CABG in ≥75 year-old patients with severe CAD.

Methods: A total of 1454 elderly patients (≥75 year-old patients) underwent coronary artery revascularization between January 2005 and December 2009. Patients were selected in the study if they have one of the Class-I indications for CABG. Groups were divided according to the type of procedure, PCI or MICS-CABG, and 5 year follow-up.

Results: Among 175 elderly patients, 109 underwent PCI and 66 had MICS-CABG. There was no significant difference observed in both groups with long-term all-cause mortality (31 PCI vs 21% MICS-CABG, p=0.151) and the overall 5 year survival was similar on Kaplan-Meier curve (Log rank p=0.318). The average length of stay in hospital was significantly shorter in the PCI than in the MICS-CABG group (4.3 vs 7.8 days, p<0.001). Only 4.7% of the PCI group were discharged to rehabilitation facility compared with 43.9% of the MICS-CABG group (p<0.001). The rate of repeat revascularization was significantly higher in the PCI group than in the MICS-CABG group (15 vs 3%, p=0.014).

Conclusion: Among elderly patients, long-term all-cause mortality is similar after PCI and MICS-CABG. However, there is a significantly higher rate of repeat revascularization after PCI.

Keywords: Coronary artery disease; Elderly; MICS-CABG; PCI.

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Figures

Fig. (1)
Fig. (1)
Long term mortal ity in elderly patients underwent PCI and MICS-CABG (P=0.150).
Fig. (2)
Fig. (2)
Kaplan-Meier curve of survival in elderly patients underwent PCI and MICS-CABG (P = 0.318).
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