Is bypass surgery better than stents for patients over 75 with multivessel coronary artery disease?

For patients over 75 with multivessel coronary artery disease, choosing between bypass surgery (CABG) and stents (PCI) is a major decision. Research suggests that CABG may lead to better long-term survival and fewer repeat procedures, but it also carries higher upfront risks, especially for older adults. The best choice depends on your overall health, frailty, and personal preferences.

What the research says

A large pooled analysis of 11 randomized trials found that CABG reduced 5-year mortality compared with PCI using stents in patients with multivessel disease ⁹. This benefit was consistent across subgroups, including older patients ⁹. The FAME 3 trial, which used modern stents and guided PCI with fractional flow reserve, reported that at 5 years, CABG still had a lower rate of death, stroke, or heart attack than PCI ¹⁰. Another large observational study from Ontario, Canada, showed that patients who received CABG with multiple arterial grafts had better 5-year survival and fewer heart attacks or repeat revascularizations compared with those who got second-generation drug-eluting stents ¹¹. However, PCI is less invasive and has a lower risk of stroke in the short term ¹¹. A study that specifically looked at high-risk patients (including those over 75) found mixed outcomes over 5 years, suggesting that the benefits of CABG versus PCI may vary depending on individual patient profiles ².

What to ask your doctor

• Given my age and overall health, what are the specific risks of CABG versus PCI for me?
• How does my frailty level or other medical conditions affect which option is safer?
• What is the expected recovery time and quality of life after each procedure?
• How many repeat procedures might I need if I choose stents instead of bypass surgery?
• Would using multiple arterial grafts during CABG improve my long-term outlook?