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ACC: CABG Beats PCI for Long-Term Survival in Older Adults

Grafting the more effective revascularization strategy in older adults with multivessel disease

TUESDAY, March 27 (HealthDay News) -- For older adults with multi-artery disease, long-term survival is better for those who undergo coronary-artery bypass grafting (CABG) rather than percutaneous coronary intervention (PCI), according to a study published online March 27 in the New England Journal of Medicine to coincide with presentation at the annual meeting of the American College of Cardiology, held from March 24 to 27 in Chicago.

To compare the rates of long-term survival after PCI and CABG, William S. Weintraub, M.D., of the Christiana Care Health System in Newark, Del., and colleagues analyzed data linked from the American College of Cardiology Foundation National Cardiovascular Data Registry and the Society for Thoracic Surgeons Adult Cardiac Surgery Database to claims data from the Centers for Medicare and Medicaid Services.

The researchers found that 86,244 patients, aged 65 years and older, who had two- or three-vessel coronary artery disease without acute myocardial infarction underwent CABG, and 103,549 underwent PCI. There was no significant between-group difference in adjusted mortality at one year (6.24 percent in the CABG group versus 6.55 percent in the PCI group; risk ratio [RR], 0.95; 95 percent confidence interval [CI], 0.90 to 1.00). At four years, mortality was lower with CABG than with PCI (16.4 versus 20.8 percent; RR, 0.79; 95 percent CI, 0.76 to 0.82).

"In this observational study, we found that, among older patients with multivessel coronary disease that did not require emergency treatment, there was a long-term survival advantage among patients who underwent CABG as compared with patients who underwent PCI," the authors write.

Several authors disclosed financial ties to the pharmaceutical and medical device industries. One author has provided expert testimony on a related matter.

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