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



Emad A. Barsoum1, *, Basem Azab2, Nileshkumar Patel1, Jonathan Spagnola1, Masood A. Shariff3, Umar Kaleem1, Rewais Morcus1, Deepak Asti4, Joseph T. McGinn, Jr2, 3, James Lafferty4, Donald A. McCord4
1 Department of Medicine, Staten Island University Hospital, North Shore-LIJ Health System, Staten Island, New York, USA
2 Department of General Surgery, Staten Island University Hospital, North Shore-LIJ Health System, Staten Island, New York, USA
3 Department of Cardiothoracic Surgery, Staten Island University Hospital, North Shore-LIJ Health System, Staten Island, New York, USA
4 Department of Cardiology, Staten Island University Hospital, North Shore-LIJ Health System, Staten Island, New York, USA


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© Barsoum et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution-Non-Commercial 4.0 International Public License (CC BY-NC 4.0) (https://creativecommons.org/licenses/by-nc/4.0/legalcode), which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Department of Medicine, Staten Island University Hospital, North Shore-LIJ Health System, Staten Island, New York, USA; Tel: 3476669321; Fax: 7182268695; E-mail: ebarsoum@nshs.edu.


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.