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Coronary artery bypass surgery in the elderly
1Mount Elizabeth Medical Centre, Singapore.
Insights
Advancing age is an independent risk factor for complications after coronary artery bypass grafting (CABG). However, elderly patients with unstable angina may still benefit from CABG, improving their quality of life.
Area of Science:
- Cardiology
- Cardiac Surgery
- Geriatric Medicine
Background:
- Coronary artery disease (CAD) is a leading cause of mortality worldwide.
- Coronary artery bypass grafting (CABG) is a common surgical intervention for CAD.
- The impact of aging on CABG outcomes requires ongoing investigation.
Purpose of the Study:
- To evaluate the influence of advanced age on patient outcomes after CABG for isolated CAD.
- To identify age-related risk factors associated with complications and mortality following CABG.
Main Methods:
- Retrospective review of 370 patients undergoing CABG for isolated CAD between January 1985 and June 1989.
- Analysis of patient demographics, comorbidities, surgical factors, and postoperative outcomes.
- Univariate and multivariate regression analyses to determine significant risk factors.
Main Results:
- Overall mortality was 2.7% and complications occurred in 26.8% of patients.
- Advanced age (≥65 years), comorbidities, poor left ventricular function, and left main stem disease were significant risk factors.
- Increasing age beyond 65 years emerged as an independent risk factor for adverse outcomes.
Conclusions:
- While advanced age is an independent risk factor for CABG complications, elderly patients with severe, unstable angina should not be excluded from surgical consideration.
- CABG can lead to improved quality of life in carefully selected elderly patients.
- Risk stratification and patient selection are crucial for optimizing outcomes in older adults undergoing CABG.
Abstract:
This review of all patients operated on for isolated coronary artery disease from January 1985 to June 1989, was undertaken to determine the impact of advancing age on their final outcome following coronary artery bypass grafting. Three hundred and seventy patients were studied, 147 (39.7%) were less than 55 years old, 141 (38.1%) between 55 and 64 years, 55 (14.6%) between 65 and 69 years and 28 (7.6%) were aged 70 years and above. There were 10 deaths (2.7%) and 99 complications (26.8%). Using univariate analysis, advance age, the presence of some concomitant diseases, poor left ventricular function and left main stem disease were found to be significant risk factors. Patients with four or more grafts and those who underwent emergency or urgent surgery were also at greater risk of developing complications including death. Multivariate regression analysis revealed that increasing age beyond 65 years was an independent risk factor. Inspite of the above findings, it is recommended that elderly patients with uncontrollable unstable angina should not be denied surgery in view of their improved quality of life after surgery.