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Long-term follow-up after bypass surgery or coronary stenting in elderly with multivessel disease
BACKGROUND: We sought to compare long-term follow-up of coronary artery bypass grafting (CABG) with percutaneous coronary intervention (PCI) in elderly patients with left main or multivessel disease, hypothesising that completeness of revascularisation and severity of coronary artery disease are pre...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Bohn Stafleu van Loghum
2020
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7431514/ https://www.ncbi.nlm.nih.gov/pubmed/32333255 http://dx.doi.org/10.1007/s12471-020-01415-z |
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author | Gimbel, M. E. Willemsen, L. M. Daggelders, M. C. Kelder, J. C. Oirbans, T. Beukema, K. F. Daeter, E. J. ten Berg, J. M. |
author_facet | Gimbel, M. E. Willemsen, L. M. Daggelders, M. C. Kelder, J. C. Oirbans, T. Beukema, K. F. Daeter, E. J. ten Berg, J. M. |
author_sort | Gimbel, M. E. |
collection | PubMed |
description | BACKGROUND: We sought to compare long-term follow-up of coronary artery bypass grafting (CABG) with percutaneous coronary intervention (PCI) in elderly patients with left main or multivessel disease, hypothesising that completeness of revascularisation and severity of coronary artery disease are predictors of adverse outcomes. METHODS: Patients aged ≥75 years with multivessel disease or left main disease who underwent PCI or CABG between 2012–2016 were included in this retrospective cohort study. Baseline characteristics from the index procedure were collected. Severity of coronary artery disease and completeness of revascularisation were assessed. Primary outcome was all-cause mortality, in addition we captured major adverse cardiac and cerebral events, bleedings, recurrent angina and new onset atrial fibrillation. RESULTS: A total of 597 patients were included. Median follow-up was 4 years (interquartile range 2.8–5.3 years). At baseline, patients in the PCI group more often had a previous medical history of CABG and more frequently underwent an urgent procedure compared with patients in the CABG group. Mortality at 5‑year follow-up was significantly higher in patients who underwent PCI compared with CABG (39.9% vs 25.4%, p < 0.001). Furthermore, acute coronary syndrome (ACS), repeat revascularisation and recurrent angina occurred more frequently after PCI, while occurrence of bleedings and new onset atrial fibrillation were more frequent after CABG. Neither completeness of revascularisation nor severity of coronary artery disease was a predictor for any of the outcomes. CONCLUSION: Long-term mortality was higher in elderly patients with multivessel disease undergoing PCI compared with CABG. In addition, patients undergoing PCI had a higher risk of ACS, repeat revascularisation and recurrent angina. |
format | Online Article Text |
id | pubmed-7431514 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Bohn Stafleu van Loghum |
record_format | MEDLINE/PubMed |
spelling | pubmed-74315142020-08-24 Long-term follow-up after bypass surgery or coronary stenting in elderly with multivessel disease Gimbel, M. E. Willemsen, L. M. Daggelders, M. C. Kelder, J. C. Oirbans, T. Beukema, K. F. Daeter, E. J. ten Berg, J. M. Neth Heart J Original Article BACKGROUND: We sought to compare long-term follow-up of coronary artery bypass grafting (CABG) with percutaneous coronary intervention (PCI) in elderly patients with left main or multivessel disease, hypothesising that completeness of revascularisation and severity of coronary artery disease are predictors of adverse outcomes. METHODS: Patients aged ≥75 years with multivessel disease or left main disease who underwent PCI or CABG between 2012–2016 were included in this retrospective cohort study. Baseline characteristics from the index procedure were collected. Severity of coronary artery disease and completeness of revascularisation were assessed. Primary outcome was all-cause mortality, in addition we captured major adverse cardiac and cerebral events, bleedings, recurrent angina and new onset atrial fibrillation. RESULTS: A total of 597 patients were included. Median follow-up was 4 years (interquartile range 2.8–5.3 years). At baseline, patients in the PCI group more often had a previous medical history of CABG and more frequently underwent an urgent procedure compared with patients in the CABG group. Mortality at 5‑year follow-up was significantly higher in patients who underwent PCI compared with CABG (39.9% vs 25.4%, p < 0.001). Furthermore, acute coronary syndrome (ACS), repeat revascularisation and recurrent angina occurred more frequently after PCI, while occurrence of bleedings and new onset atrial fibrillation were more frequent after CABG. Neither completeness of revascularisation nor severity of coronary artery disease was a predictor for any of the outcomes. CONCLUSION: Long-term mortality was higher in elderly patients with multivessel disease undergoing PCI compared with CABG. In addition, patients undergoing PCI had a higher risk of ACS, repeat revascularisation and recurrent angina. Bohn Stafleu van Loghum 2020-04-24 2020-09 /pmc/articles/PMC7431514/ /pubmed/32333255 http://dx.doi.org/10.1007/s12471-020-01415-z Text en © The Author(s) 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. |
spellingShingle | Original Article Gimbel, M. E. Willemsen, L. M. Daggelders, M. C. Kelder, J. C. Oirbans, T. Beukema, K. F. Daeter, E. J. ten Berg, J. M. Long-term follow-up after bypass surgery or coronary stenting in elderly with multivessel disease |
title | Long-term follow-up after bypass surgery or coronary stenting in elderly with multivessel disease |
title_full | Long-term follow-up after bypass surgery or coronary stenting in elderly with multivessel disease |
title_fullStr | Long-term follow-up after bypass surgery or coronary stenting in elderly with multivessel disease |
title_full_unstemmed | Long-term follow-up after bypass surgery or coronary stenting in elderly with multivessel disease |
title_short | Long-term follow-up after bypass surgery or coronary stenting in elderly with multivessel disease |
title_sort | long-term follow-up after bypass surgery or coronary stenting in elderly with multivessel disease |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7431514/ https://www.ncbi.nlm.nih.gov/pubmed/32333255 http://dx.doi.org/10.1007/s12471-020-01415-z |
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