Comparison of Coronary Revascularization Procedures in Octogenarians: a Systematic Review and Meta-analysis

Background: Elderly patients are the fastest growing population in the US healthcare system and more patients aged 80 years and older require CABG or percutaneous coronary intervention (PCI) for coronary revascularization than ever before. Because octogenarian patients have not been adequately represented in randomized trials comparing CABG and PCI, the most appropriate method of revascularization for this group of patients has not been determined.

Methods: We performed a systematic review and a meta-analysis of 66 studies of coronary revascularization in patients aged over 80 years. The primary endpoints included 30 day mortality and long-term survival. Subgroup analyses stratified by revascularization type (PCI versus CABG) were also performed.

Results: Pooled estimate of 30 day mortality was 6.3% (95% CI 5.3%-7.5%), and for survival at 1, 3 and 5 years, 86% (84%-88%), 78% (74%-81%) and 67% (61%-72%), respectively. A greater number of men (P <0.001) and patients with multivessel disease (P = 0.004) were treated with CABG than with PCI. Pooled estimates, based on type of revascularization, of 30 day mortality and 1 year survival were similar (7.3% [6.3%-8.2%] for CABG vs 5.4% [4.4%-6.4%] for PCI and 86% [83%-88%] for CABG vs 87% [84%-91%] for PCI, respectively).

Conclusions: Available data indicate that revascularization can be performed in octogenarians with acceptable short-term and long-term outcomes; most of the evidence is, however, low level. Furthermore, it is unclear whether octogenarians derive greater survival benefit from CABG or from PCI because preprocedural risk profiles differ between intervention types. Periprocedural and long-term outcomes are, however, equivalent, and randomized, controlled trials of high-risk octogenarians are needed.