Influence of internal mammary artery grafting and completeness of revascularization on long-term outcome in...

It has been well established that complete revascularization with internal mammary artery (IMA) grafting is important in young patients undergoing coronary artery bypass grafting (CABG). Applying these principles to octogenarians remains controversial.

From 1986 to 1999, 358 consecutive patients aged 80 to 94 years underwent CABG. Revascularization was complete in 291 (81%) and incomplete in 67 (19%). The IMA was used in 231 (65%) cases.

Operative mortality was 7% +/- 1%, but was not statistically different with or without IMA grafting (IMA 5% +/- 2% versus no IMA 10% +/- 3%, p = 0.11) or complete revascularization (p > 0.41). Midterm survival improved with IMA grafting (70% +/- 3% versus 56% +/- 5% at 4 years, p < 0.03; 36% +/- 4% versus 29% +/- 5% at 8 years, p < 0.08), but was not significant beyond 8 years. Among 138 survivors, those with IMA grafts were more likely to be angina free (82% versus 53%, p < 0.001) and in New York Heart Association class I (60% versus 36%, p < 0.03). Survival, recurrent angina, and functional class were independent of completeness of revascularization (p > 0.21).

IMA grafting improved survival, angina, and functional class of octogenarians, but complete revascularization did not have a similar impact.