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Coronary artery bypass grafting in the elderly
1Department of Cardiovascular Surgery, Shin-Tokyo Hospital, Chiba, Japan. genex@idt.net
Insights
Coronary artery bypass grafting (CABG) in elderly patients shows increased surgical risks and lower long-term survival. However, the cardiac event-free rate after CABG is similar to younger patients.
Area of Science:
- Cardiovascular Surgery
- Geriatric Medicine
- Clinical Outcomes Research
Background:
- Increasing incidence of coronary artery bypass grafting (CABG) in elderly populations.
- Need to evaluate surgical outcomes and long-term prognosis in older patients undergoing CABG.
Purpose of the Study:
- To compare the outcomes of CABG in patients aged 75 years and older with those in younger patients.
- To assess perioperative risks, postoperative course, and long-term survival and cardiac event-free rates.
Main Methods:
- Retrospective analysis of CABG patients at Shin-Tokyo Hospital (1991-1998).
- Comparison of elderly (>=75 years, n=190) and younger (<75 years, n=1,380) patient groups.
- Collection and analysis of preoperative, perioperative, and follow-up data.
Main Results:
- Elderly group (Group E) had higher rates of female gender, emergent CABG, preoperative balloon pumping, cardiogenic shock, hypertension, and prior stroke.
- Group E showed less use of bilateral internal mammary artery, more use of saphenous vein, and higher blood transfusion rates.
- Postoperative course in Group E involved longer intubation, ICU stay, hospital stay, and higher rates of major complications and in-hospital death.
- Actuarial 5-year survival (excluding in-hospital mortality) was lower in Group E (84.3%) compared to Group Y (92.5%).
- Actuarial 5-year cardiac event-free rates were similar: 79.9% in Group E vs. 79.7% in Group Y.
Conclusions:
- CABG in elderly patients is associated with increased surgical risks and mortality.
- Despite risks, long-term cardiac event-free rates after CABG are comparable between elderly and younger patients.
- Inferior long-term survival in the elderly is likely attributable to the aging process itself.
Background And Methods:
The incidence of coronary artery bypass grafting (CABG) in elderly patients has been increasing. We retrospectively analyzed the results of CABG performed at Shin-Tokyo Hospital between January 1, 1991, and December 31, 1998. Preoperative, perioperative, and follow-up data of patients > or = 75 years old (group E, n = 190) were collected, and compared with those of patients < 75 years old (group Y, n = 1,380).
Results:
Female gender, emergent CABG, preoperative balloon pumping use, cardiogenic shock, hypertension, and preoperative cerebral vascular accident were significantly more frequent in group E (p < 0.05). CABG was completed without any significant differences, except for less frequent use of the bilateral internal mammary artery (p < 0.01), more frequent use of the saphenous vein (p < 0.005), and a greater incidence of blood transfusion in group E (p < 0.0001). The postoperative course required longer intubation, ICU stay, and postoperative hospital stay in group E (p < 0.001), and was more frequently associated with major complication (p < 0.0001) and in-hospital death (p < 0.05). During the mean follow-up of 2.7 years (maximum 6.9 years), the actuarial 5-year survival of groups E and Y were 84.3% and 92.5% (p < 0.01), respectively, excluding in-hospital mortality. The actuarial 5-year cardiac event-free rates were 79.9% in group E and 79.7% in group Y, showing no significant difference.
Conclusions:
CABG in the elderly carries certain surgical risks. However, the long-term cardiac event-free rate after CABG in the elderly was almost the same as that of younger patients. Inferior long-term survival in the elderly was most likely due to the biological nature of aging.