Objectives: Little data are available to compare coronary artery bypass graft surgery (CABG) vs percutaneous coronary intervention (PCI) with drug-eluting stents (DES) in older adults. We evaluate the long-term outcomes of CABG vs PCI with DES in older adults with left main or multivessel coronary artery disease (CAD).
Design: Individual patient-level meta-analysis.
Settings: Databases from the BEST, PRECOMBAT, and SYNTAX trials were combined.
Participants: A total 1,079 adults aged 70 to 89 years were pooled.
Measurements: The primary outcome was a composite of death from any causes, myocardial infarction, stroke, or repeat revascularization.
Results: During a total of 6.3 (median, 4.9) years of follow-up, the primary composite outcome of all-cause mortality, myocardial infarction, stroke, or repeat revascularization occurred in 26% (141/550) and 34% (179/529) of patients in the CABG and PCI groups, respectively (hazard ratio (HR), 0.75; 95% confidence interval (CI), 0.60-0.94; P = .012). CABG was associated with fewer myocardial infarction (4% vs 8% for PCI; HR, 0.48; 95% CI, 0.29-0.80; P = .037); and repeat revascularizations (8% vs 17% for PCI; HR, 044; 95% CI, 0.31-0.64; P < .001), but had little association with all-cause mortality or stroke.
Conclusion: Older adults age 70 to 89 years with left main or multivessel CAD who participated in the BEST, PRECOMBAT, and SYNTAX trials; compared to PCI, CABG was associated with lower risk of primary outcome which was mostly driven by lower risk of myocardial infarction.

Additional Metadata
Keywords Coronary artery bypass graft surgery, Drug-eluting stents, Left main coronary artery disease, Multivessel coronary artery disease, Older
Persistent URL dx.doi.org/10.1111/jgs.14780, hdl.handle.net/1765/98015
Journal American Geriatrics Society. Journal
Citation
Chang, M, Lee, M.S, Ahn, J.-M. (Jung-Min), Cavalcante, R, Sotomi, Y, Onuma, Y, … Park, S.-J. (2017). Outcomes of Coronary Artery Bypass Graft Surgery Versus Drug-Eluting Stents in Older Adults. American Geriatrics Society. Journal. doi:10.1111/jgs.14780