Revascularization in Patients Over 75 With Acute Coronary Syndrome.

Observational data have demonstrated that patients presenting with acute coronary syndromes (ACS) and multivessel coronary artery disease (MV-CAD) experience improved 1-year outcomes including lower rates of death, rehospitalization, and repeat ACS when treated with coronary artery bypass graft (CABG) compared with percutaneous coronary intervention (PCI) and medical management (MM). However, limited data exists that studies these practices in adults over the age of 75. This retrospective, multi-centered, observational study from 2018 to 2022 from a healthcare center in Texas compared outcomes among patients with ACS and MV-CAD, stratified by revascularization strategy and age group (<75 vs ≥75 years). The primary endpoint was 1 year mortality, and secondary endpoints include readmission or myocardial infarction (MI) within 1 year, index length of stay, and repeat revascularization within 30 days and 1 year. Cox proportional hazards modeling was used to evaluate the effect of age on mortality outcomes. A total of 2161 patients met inclusion criteria (n = 1559 CABG, n = 295 PCI, and n = 307 MM). There were 1547 patients under the age of 75 (median age 63.82, IQR = 57.24, 69.44) and 614 over the age of 75 (median age 80.43, IQR = 77.62-84.58). Patients who underwent CABG had significantly reduced mortality compared with PCI or MM (RR = 0.324, CI 0.172 to 0.612, p <0.0001). In conclusion, CABG was associated with improved and comparable outcomes in patients with ACS and MV-CAD both under and over 75 years of age compared with PCI and MM.