Outcomes of Coronary Artery Bypass Graft Surgery Versus Drug‐Eluting Stents in Older Adults

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.