Advanced Clinician Scientist-Programm 2025

Thema: "Coronary Artery BypAss Grafting vs. pErcutaneous coronary intervention in patients of older age-CAB-AGE"

Zusammenfassung:
CAD is a common disease often leading to MI as one of the leading causes of global mortality. One third of all of MI occur in individuals 75years and older. In addition, MI mortality risk is also elevated so that 60% of all MI-deaths occur above 75. CABG has the greatest potential to prevent MI in chronic CAD by providing surgical collaterals to all CAD preventing acute ischemia in case of native vessel occlusion. Thus, CABG should have its greatest treatment potential in elderly patients However, current guidelines favor PCI in older patients due to the perception of high surgical risk and an often frail patient status in this age group. Yet, the available evidence (which stems mainly from younger patient populations) even suggests comparable 30-day mortality rates between CABG and PCI and significantly better long-term outcomes with CABG. To date, no randomized comparison has addressed the impact of frailty or the direct effects of CABG vs. PCI in the elderly. Such data are urgently needed, as current treatment recommendations are based on potentially erroneous beliefs, which may adversely affect significant numbers of patients worldwide. It is therefore the goal of my project to generate this information by a two-step process. First, conduct a single center trial to assess the impact of PCI and CABG on frailty in patients 75 years of age and above (CAB-AGE I-Trial) and second, organize a prospective, multicenter randomized controlled trial (RCT) assessing the impact of CABG and PCI on long-term outcomes-CAB-AGE II Trial (the latter project will use the GermaN HeaRTS Network for national conduct and negotiations with the US-surgical CTSN trials network are ongoing).