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Adverse events similar for PCI, CABG in older patients with unprotected left main CAD
A meta-analysis has concluded that patients aged at least 70 years with unprotected left main CAD have comparable rates of all-cause mortality, nonfatal MI and MACCE after undergoing PCI or CABG.
Mahboob Alam, MD, study researcher with Baylor College of Medicine, and fellow investigators reviewed all-cause mortality, nonfatal MI, stroke, repeat revascularization and MACCE at 30 days,12 months and 22 months in 10 studies of 2,386 patients (PCI, n=909; CABG, n=1,477) with unprotected left main CAD.
Patients who underwent PCI were more likely than those who underwent CABG to present with ACS (59.6% vs. 44.8%; P<.001). PCI was associated with fewer days in the hospital (4.2 ± 0.8 vs. 8.3 ± 0.01; P<.001). There were no significant differences between the two procedures for all-cause mortality, nonfatal MI and MACCE at 30 days, 12 months and 22 months.
Mahboob Alam
PCI was associated with lower rates of stroke at 30 days (OR=0.14; 95% CI, 0.02-0.76) and 12 months (OR=0.14; 95% CI, 0.03-0.60). PCI also was associated with higher rates of repeat revascularization at 22 months (OR=4.34; 95% CI, 2.69-7.01). These findings were consistent with a subgroup analysis of patients aged at least 75 years and older.
“The interventional strategy in older patients needs to be individualized based on multiple factors, including coexisting medical comorbidities, as mortality rates are comparable between surgical and percutaneous coronary revascularization,” Alam told Cardiology Today’s Intervention. “The increased risk of early stroke in older patients undergoing CABG should also be taken seriously, as it may severely impact the quality of life in these elderly patients.”
Disclosure: The researchers report no relevant financial disclosures.