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Five-year results of off pump coronary artery bypass grafting and percutaneous coronary intervention with drug eluting stent for multivessel coronary artery disease in elderly patients.
Kenichi Sasaki, Toshihiro Fukui, Minoru Tabata, Shuichiro Takanashi.
Sakakibara Heart Institute, Fuchu-shi, Japan.
OBJECTIVE: The number of elderly patients with multivessel coronary artery disease is increasing, but optimal treatment strategy has not been well defined. We compared five year outcomes between coronary artery bypass grafting (CABG) and percutaneous coronary intervention with drug eluting stent (DES) in elderly patients.
METHODS: We reviewed 262 patients ( ≥80 years) with multivessel coronary artery disease ( 2VD or 3VD) and/or left main disease. Among them, 98 patients ( 37.4%) underwent CABG and 164 patients ( 62.6%) underwent DES between January 2005 and December 2010. All CABGs were performed by off-pump technique. Median follow-up was 35.1 months. There were no differences in the mean age( CABG 82.6±2.7 vs. PCI 82.9±3.2 years, P=0.359)and the prevalence of acute coronary syndrome ( 61.2% vs. 48.9%, P=0.05) between CABG and DES groups. CABG group had a higher prevalence of left main lesions ( 41.8% vs. 10.9%, P<0.01) and 3vessels disease( 81.6% vs. 31.1%, P<0.01) compared with DES group. The mean number of distal anastomoses was 3.7±1.1 in CABG group. Bilateral ITAs were used 76.5% of patients and single ITA was used in 22.4% of patients in CABG group.
RESULTS: Thirty day mortality was 2.1% and 0.6% in CABG group and DES group, respectively ( P=0.65). At 5 years, there was no significant difference between both groups in freedom from all-cause mortality ( CABG 69.0% vs. PCI 75.4%, P=0.38), the freedom from cardiovascular related-mortality ( 93.1% vs. 91.6%, P=0.43) and the freedom from major adverse cardiac and cerebrovascular events ( MACCE; 64.1% vs. 68.7%, P=0.52). However, CABG group had a lower incidence of repeat revascularization compared with PCI at 5years ( CABG 1.7% vs. PCI 13.0%, P<0.05).
CONCLUSIONS : Five-year survival rate and MACCE free rate were not significantly different between CABG and PCI group in elderly patients ( ≥80 years). Revascularization rate was higher in the PCI group compared with CABG group. Cardiovascular related-death rate was low in the both groups.
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