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Coronary bypass for left main disease in patients over 70 years of age
Insights
Coronary artery bypass surgery for elderly patients with left main coronary artery disease offers low operative mortality and improved quality of life. Unstable angina requiring intravenous nitroglycerin was a key predictor of hospital mortality in this group.
Area of Science:
- Cardiovascular Surgery
- Geriatric Cardiology
- Interventional Cardiology
Background:
- Left main coronary artery (LMCA) disease poses significant risk, especially in elderly patients.
- Elderly patients (over 70) with LMCA disease often present with severe symptoms and complex coronary artery disease.
- Optimal management strategies for LMCA disease in the elderly remain a critical area of study.
Purpose of the Study:
- To evaluate the safety and efficacy of isolated coronary artery bypass grafting (CABG) for LMCA disease in patients over 70 years of age.
- To assess operative mortality, hospital stay, and long-term outcomes, including quality of life.
- To identify predictors of hospital mortality in this specific patient cohort.
Main Methods:
- Retrospective analysis of 71 consecutive patients over 70 undergoing isolated CABG for LMCA disease (September 1975 - December 1982).
- Detailed assessment of preoperative clinical status, coronary anatomy, left ventricular function, and surgical data.
- Follow-up evaluation of cardiac mortality and quality of life.
Main Results:
- High prevalence of severe angina (64% NYHA class IV) and significant multi-vessel disease (66%).
- Hospital mortality was 7%, with unstable angina requiring intravenous nitroglycerin identified as a significant predictor of mortality (p<0.01).
- Mean follow-up of 26 months showed late cardiac mortality of 4.5%, with 75% of survivors reporting good quality of life.
Conclusions:
- Isolated CABG for LMCA disease is a viable option in non-selected elderly patients, yielding low operative mortality.
- The procedure leads to a marked improvement in the quality of life for surviving patients.
- Early identification and management of unstable angina are crucial for improving outcomes in this population.
Abstract:
Seventy-one consecutive patients over 70 years of age underwent isolated coronary bypass surgery for left main coronary artery (LMCA) disease between September 1975 and December 1982. All patients had angina; 6% were in NYHA functional class II, 30% class III, and 64% class IV. Intravenous nitroglycerin was required in 25% of patients. Resting electrocardiogram was abnormal in 91% of patients and stress testing performed in 24 patients was positive in all. Degree of left main stenosis graded by diameter was 60 to 70% in 24% of patients and greater than 70% in 76%. In addition to left main stenosis 66% of patients had significant triple vessel disease. Left ventricular end diastolic pressure (LVEDP) was elevated in 69% of patients while ejection fraction (EF) was low only 24%, without correlation between high LVEDP and low EF. Mean number of bypass grafts per patient was 3.4 +/- 0.6. Hospital mortality was 7% and mean post-operative stay was 10.4 +/- 2.0 days. Stepwise multiple regression analysis of 12 variables identified only unstable angina requiring intravenous nitroglycerin as a significant predictor of hospital mortality (p less than 0.01). Follow-up was complete with a late cardiac mortality of 4.5%. Seventy-five percent of surviving patients assessed their quality of life as good at a mean follow-up of 26 months. Coronary bypass for LMCA disease in a non-selected elderly population can be performed with low operative mortality and marked improvement in quality of life.