Original Title: Effects of Age and Sex on Clinical Outcomes after Percutaneous Coronary Intervention Relative to Coronary Artery Bypass Grafting in Patients with Triple Vessel Coronary Artery Disease. Reference: KyoheiYamaji et al. Circulation. 2016 Mar 23. [Epub ahead of print].
Sex and age are factors that are often considered in the daily practice to decide between PCI or surgery.
The multicenter CREDO-Kyoto trial included 25816 patients; 5651 (men n=3998 and women n=1653) had triple vessel CAD and were considered good candidates for revascularization both with PCI and CABG (PCI n=3,165 and CABG n=2,486).
Patients were divided in three groups according to age tertile: ≤65 years (n=1,972), 66-73 years (n=1,820), and ≥74 years (n=1,859).
There was an excess mortality risk in ≥74 year old patients undergoing PCI compared to those undergoing CABG (HR 1.40, CI 95% 1.10 to 1.79; p=0.006), whereas this risk was neutral for ≤65 year old patients (HR 1.05, CI 95% 0.73 to 1.53; p=0.78) and also neutral for the group between 66 and 73 years of age (HR 1.03, CI 95% 0.78 to 1.36; p=0.85).
The excess mortality risk in the PCI group was significant in men (HR 1.24, CI 95% 1.03 to 1.50; p=0.02) and tended to be significant in women (HR 1.34 IC 95% 0.98 a 1.84; p=0.07).
Conclusion
There was a significant association between age and mortality risk in ≥74 year old patients with triple vessel CAD undergoing PCI compared to those undergoing CABG. The risk was neutral in younger patients.