Coronary artery bypass grafting in the elderly: pros and cons after three-year follow-up

The elderly represent an ever-growing proportion of the candidates for coronary artery bypass grafting (CABG) surgery. We analyzed the effect of anticipated risks on the early and mid-term outcome of coronary surgery in septuagenarians compared with younger patients.

We analyzed 1,475 consecutive isolated CABG procedures performed at the Charles University Hospital during the 1995-1997 period and assessed their early and mid-term (3-year follow-up) results with respect to patient age. The patients were divided into two groups: younger (n = 1,324, age < 70 years) and older (n = 151, age > or = 70 years). We studied potential preoperative risk factors, perioperative parameters, and postoperative course. Data on functional status, incidence of major cardiac events, and patient satisfaction with the outcome of surgery 3 years after the operation were collected from the patients by a questionnaire survey.

The elderly had lower body mass index and body surface area, more advanced stage of disease according to the New York Heart Association and Canadian Cardiovascular Society classifications, higher prevalence of diabetes, renal dysfunction, and extracardiac arteriopathy. CABG was performed in both groups, with no procedural differences. The older group had higher mortality (7.3% vs 2.3%), incidence of NearMiss+ (outcome measure index; 36.4% vs 18.4%), and post-operative morbidity (56.3% vs 34.6%). Older patients also required longer stay at the intensive care unit and longer hospitalization. Three-year follow-up revealed identical relief of symptoms and improvement of functional status in both groups, with higher mortality in the elderly (15.3% vs 4.5%). The stroke was also more frequent in the elderly (8.6% vs 3.0%), whereas the occurrence of other non-fatal cardiac events was similar in both groups.

Coronary revascularization in the elderly carries higher but still acceptable risk. The elderly survivors showed similar functional improvement as the younger patients, but the actuarial survival was worse, mainly due to perpetuating cardiovascular illness. Surgical procedure should not be denied to elderly population based on age alone and each patient should be carefully evaluated.