Risk factors for mortality in octogenarians undergoing myocardial revascularization surgery
Isaac Newton Guimarães1, Fernando Moraes, João Paulo Segundo
1Instituto do Coração de Pernambuco, Recife, PE, Brazil.
Insights
In octogenarians undergoing coronary artery bypass grafting (CABG), advanced age (over 85) and emergency surgery significantly increase mortality risk. These factors are critical for predicting outcomes in elderly CABG patients.
Area of Science:
- Cardiovascular Surgery
- Geriatric Medicine
- Surgical Outcomes Research
Background:
- Coronary artery bypass grafting (CABG) in octogenarians presents unique challenges.
- While age is a factor, other predictors of mortality in this demographic require identification.
Purpose of the Study:
- To identify specific risk factors for mortality in patients aged 80 years and over undergoing CABG.
- To provide data for improved risk stratification and patient management.
Main Methods:
- A cohort of 164 patients aged 80+ undergoing CABG was analyzed.
- Variables included demographics, cardiac function (LVEF), surgical urgency, revascularization details, and use of support devices.
- Statistical analysis involved univariate and multivariate logistic regression.
Main Results:
- Overall mortality was 11%.
- Univariate analysis identified low ejection fraction, emergency surgery, and intra-aortic balloon use as significant predictors.
- Multivariate analysis revealed age over 85 (OR 6.31) and emergency surgery (OR 55.39) as independent predictors of mortality.
Conclusions:
- Age over 85 years is a significant predictor of mortality in octogenarian CABG patients.
- Emergency surgery dramatically increases mortality risk in this population.
- These findings are crucial for surgical decision-making and risk assessment in elderly patients.
Background:
Age over 80 years, by itself, is not the only risk factor for mortality in coronary artery bypass grafting.
Objective:
To identify risk factors for mortality in octogenarian patients undergoing CABG.
Methods:
We studied 164 patients aged 80 years and over. The variables studied were: gender; age (in years); ejection fraction (LVEF); reoperation; emergency surgery; number of revascularized arteries; use of the left internal thoracic artery (LITA); use of cardiopulmonary bypass (CPB); associated surgery; revascularization of the left anterior descending artery (DA); and use of intra-aortic balloon (IAB). Statistical analysis was done using descriptive analysis, univariate and multivariate logistic regression. A p value < 0.05 was considered statistically significant, and multivariate analysis was performed for variables whose value was p < 0.20.
Results:
Mortality was 11%. Univariate analysis showed that low LVEF (p = 0.008), emergency surgery (p < 0.001), and use of intra-aortic balloon (p = 0.049) were related to higher mortality. When adjusted by logistic regression, age over 85 years was correlated with a 6.31 times greater mortality (p = 0.012), and emergency surgery was related to a 55.39 times greater mortality (p < 0.001).
Conclusion:
In octogenarians undergoing coronary artery bypass surgery, age over 85 years and emergency surgery are important predictors of mortality.
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