Age not a limiting factor- CABG Surpasses PCI for ACS in Elders with Multimorbidity

The optimal coronary revascularization strategy to maximize the patient-centred outcome of days alive and out of hospital (DAOH), in multimorbid older (≥65-years) adults after an acute coronary syndrome (ACS) is incompletely understood. Therefore, Dr Ahmed Ijaz Shah and his team conducted a study comparing revascularization strategies (CABG Vs PCI) in elderly adults, particularly in those with age-related comorbidities.

In this study, the researchers analyzed data from the Kaiser Permanente Northern California health plan database and identified 3,871 patients 65 years and older presenting with ACS between 2010 and 2018 who were subsequently treated with CABG (n = 1,575) or PCI (n = 2,296) for left main or multivessel CAD. They performed a thorough propensity score modelling technique to avoid selection bias and inverse probability of treatment weighting. They further used cox proportional hazards models to evaluate the association of revascularization type with outcomes. The major outcome assessed was absolute DAOH and the relative risk of achieving ≥90%DAOH during three-time intervals. They also assessed the all-cause mortality, recurrent MI, stroke, rehospitalization, repeat revascularization, and dialysis initiation.

Key findings of the study:

• Upon analysis, the researchers found that CABG (compared to PCI) was associated with a greater absolute number of DAOH, significant after the first year (mean difference at 1-year: +5.8 days; 3-years: +56 days; 5-years: + 131 days).
• They further noted that the relative risk of achieving ≥90% DAOH significantly favoured CABG after the first year (1-year:1.02; 3-years:1.06, 5-years:1.12), and was related to lower incidences of all-cause mortality, repeat revascularization, rehospitalization, incident dialysis, and nonfatal MI with CABG.

The authors concluded, "In older adults with multivessel or left main coronary artery disease who presented with ACS, CABG, after the first year, was associated with a greater absolute number of DAOH—a geriatric and patient-centred outcome, compared to PCI. "

They further added, "CABG patients also had a higher probability of achieving ≥90%DAOH—with lower all-cause mortality, recurrent MI, repeat revascularization, new dialysis, and rehospitalization rates. Future randomized trials should study the impact of optimal revascularization strategies on the quality of life of older adults with multimorbidity."

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DOI: https://doi.org/10.1111/jgs.17794