Coronary Artery Bypass Graft Surgery in Elderly Patients With Multivessel Coronary Artery Disease is Associated with Better Outcomes

Introduction: The appropriate revascularization strategy for elderly patients with multivessel CAD is unclear. Hypothesis: We hypothesized that the rate of death, MI, and revascularization would be lower in elderly patients with multivessel CAD who receive revascularization with CABG. Methods: We used the Duke Databank for Cardiovascular Disease from 10/01/2003 through 06/30/2013 to identify patients ≥ 75 years old with multivessel disease, and treatment with PCI or CABG within 30 days of index catheterization. Exclusions included STEMI, left main disease, and significant valvular disease. The primary outcome was a composite of all-cause death, MI, and coronary revascularization through latest follow-up. The outcomes were examined across initial revascularization therapies including bare metal stents, drug-eluting stents, and CABG. Unadjusted estimates were assessed with Kaplan-Meier time-to-event methods. Multivariable Cox proportional hazards modeling was used to assess adjusted relationships with outcome. Results: We identified 763 patients who met criteria (BMS n=202, DES n=411, CABG n=150). The median age was 79 years and the median follow up time was 6.28 years. Unadjusted primary outcome rates per 100 patient-years of follow up were 22.41% for BMS, 16.97% for DES, and 12.39% for CABG. After adjustment, both BMS and DES were associated with a higher risk of the primary outcome. BMS versus CABG HR=1.58 (1.15-2.19, p=0.01). DES versus CABG HR=1.45 (1.08-1.95, p=0.01). The adjusted event rate for PCI with DES versus BMS was not significant, HR=0.92 (0.71-1.19, p=0.51). Conclusions: In this retrospective single center analysis of 763 elderly patients with multivessel coronary disease, CABG was associated with a significantly lower rate of death, MI, and revascularization when compared with initial revascularization with bare metal or drug-eluting stents. This may reflect selection of healthier patients taken for bypass surgery.