This study compared CABG vs. multivessel PCI for stable multivessel CAD in Medicare beneficiaries ≥65 years (2018–2023), using propensity score-matched groups (n=9,206 per arm) from the CMS database with doubly-robust risk adjustment.
Over 6 years, CABG was associated with superior survival (HR 0.44, 95% CI 0.40–0.49), lower MI risk (HR 0.40, 0.36–0.44), dramatically fewer reinterventions (HR 0.10, 0.08–0.14), and better composite event-free survival (89.2% vs. 71.1%; HR 0.38, 0.35–0.41); all P<0.001.
- Observational design limits causal inference despite robust matching; unmeasured confounders (e.g., anatomical complexity, operator experience) may persist. - Restricted to Medicare beneficiaries ≥65 years, limiting generalizability to younger or privately insured patients. - Administrative claims data may misclassify procedures or comorbidities compared to clinical registry-level detail.
For older adults (≥65) with stable multivessel CAD, these real-world data strongly favor CABG over PCI for long-term survival and freedom from MI and repeat revascularization. Clinicians should weigh these contemporary findings when discussing revascularization strategy, especially in light of recent guideline updates that expanded PCI indications.
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