For seniors, CABG less risky than PCI across long term

NEJM: Mortality lower for CABG patients after four years

Seniors with coronary artery disease face a lower risk of death over time if they undergo coronary artery bypass graft surgery (CABG) rather than percutaneous coronary intervention (PCI), according to a study in NEJM.

For the study—which was discussed this week at the American College of Cardiology conference in Chicago—researchers from Delaware-based Christiana Care Health System analyzed data for nearly 190,000 Medicare beneficiaries with multi-vessel heart disease who underwent treatment between 2003 and 2007.

The study found that mortality rates were similar between the two groups after one year; however, after four years, 16.4% of CABG patients died, compared with 20.8% of PCI patients.

The researchers note that differences in patients' preferences and overall health could have accounted for some of the results. For example, it is possible that patients could have been referred for PCI because they were too sick to undergo surgery, the Wall Street Journal reports.

Although William Weintraub, the study's lead author, said he does not think the study will cause an immediate change in clinical practice, he notes that people could "give surgery another thought, especially for sicker patients."

In addition, Weintraub said the findings underscore the need for more collaboration among surgeons and interventional cardiologists to ensure patients are properly evaluated and informed of their options (Winslow, Wall Street Journal, 3/27; Gardner, HealthDay, 3/27; Marchione, AP/Sacramento Bee, 3/27).

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