Effect of increasing age on percutaneous coronary intervention vs coronary artery bypass grafting in older adults with unprotected left main coronary artery disease: A meta‐analysis and meta‐regression

BACKGROUND: Older adults (≥70‐year‐old) are under‐represented in the published data pertaining to unprotected left main coronary artery disease (ULMCAD). Hypothesis: Percutaneous coronary intervention (PCI) might be comparable to coronary artery bypass grafting (CABG) for revascularization of ULMCAD. METHODS: We compared PCI versus CABG in older adults with ULMCAD with an aggregate data meta‐analyses (4880 patients) of clinical outcomes [all‐cause mortality, myocardial infarction (MI), repeat revascularization, stroke and major adverse cardiac and cerebrovascular events(MACCE)] at 30 days, 12‐24 months & ≥36 months in patients with mean age ≥70 years and ULMCAD. A meta‐regression analysis evaluated the effect of age on mortality after PCI. Odds ratios (OR) and 95% confidence intervals (CI) were estimated using random‐effects model. RESULTS: All‐cause mortality between PCI and CABG was comparable at 30‐days (OR0.77, 95% CI 0.42‐ 1.41) and 12‐24‐months (OR 1.22, 95% CI 0.78‐1.93). PCI was associated with a markedly lower rate of stroke at 30‐day follow‐up in octogenarians (OR 0.14, 95% CI 0.02‐0.76) but an overall higher rate of repeat revascularization. At ≥36‐months, MACCE (OR 1.26,95% CI 0.99‐1.60) and all‐cause mortality (OR 1.39, 95% CI 1.00‐1.93) showed a trend favoring CABG but did not reach statistical significance. On meta‐regression, PCI was associated with a higher mortality with advancing age (coefficient=0.1033, p=0.042). CONCLUSIONS: PCI was associated with a markedly lower rate of early stroke in octogenarians as compared to CABG. All‐cause mortality was comparable between the two arms with a trend favoring CABG at ≥36‐months.PCI was however associated with increasing mortality with advancing age as compared to CABG.