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
Background—Age and sex were important considerations on the choice between percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in daily clinical practice.
Methods and Results—In 25,816 patients enrolled in the multicenter CREDO-Kyoto registry (Cohort-1: N=9,877, and Cohort-2: N=15,939), the current study population consisted of 5,651 patients (men: N=3,998, and women: N=1,653) with triple vessel coronary artery disease who were considered to be pertinent in comparing PCI with CABG (PCI: N=3,165, and CABG: N=2,486). Patients were divided into 3 groups according to the tertiles of age: ≤65 years (N=1,972), 66-73 years (N=1,820), and ≥74 years (N=1,859). The excess adjusted mortality risk of PCI relative to CABG was significant in patients ≥74 years of age (HR 1.40 [95% CI 1.10-1.79], P=0.006), while the risks were neutral in patients ≤65 years of age (HR 1.05 [95% CI 0.73-1.53], P=0.78) and in patients 66-73 years of age (HR 1.03 [95%CI 0.78-1.36], P=0.85) (interaction P=0.003). The excess mortality risk of PCI relative to CABG was significant in men (HR 1.24 [95% CI 1.03-1.50], P=0.02), and trended to be significant in women (HR 1.34 [95% CI 0.98-1.84], P=0.07), without significant interaction between sex and the mortality risk of PCI relative to CABG (interaction P=0.40).
Conclusions—There was a significant association between age and the mortality risk of PCI relative to CABG with excess risk in patients ≥74 years of age and neutral risk in younger patients. There was no significant sex-related difference in the mortality risk of PCI relative to CABG.
- Received December 15, 2015.
- Revision received February 24, 2016.
- Accepted March 18, 2016.