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Published on: September 15, 2023
Isolated coronary artery bypass grafting in extracorporeal circulation in patients over 65 years old - does age still
Dawid Miśkowiec1, Andrzej Walczak2, Stanisław Ostrowski2
1Student VI roku Wydziału Lekarskiego Uniwersytetu Medycznego w Łodzi.
Insights
Older patients undergoing coronary artery bypass grafting (CABG) face significantly higher risks of complications and mortality. Advanced age is a key predictor of adverse outcomes following this cardiac surgery.
Area of Science:
- Cardiovascular Surgery
- Geriatric Medicine
- Clinical Outcomes Research
Background:
- Coronary artery bypass grafting (CABG) is increasingly performed in elderly patients.
- Assessing age-related risks is crucial for optimizing surgical outcomes in this demographic.
Purpose of the Study:
- To investigate the impact of advanced age and other risk factors on complications and early mortality after isolated CABG.
- To identify independent predictors of adverse events in patients undergoing CABG.
Main Methods:
- Retrospective analysis of medical records from 1197 patients undergoing isolated CABG.
- Patients were stratified into two groups: <65 years and ≥65 years.
- Statistical analysis was performed to compare outcomes and identify risk factors.
Main Results:
- Thirty-day mortality was six times higher in patients aged ≥65 years (7.29% vs. 1.21%).
- Older patients experienced significantly more complications, including myocardial infarction, respiratory dysfunction, and multi-organ dysfunction syndrome.
- Advanced age (≥65 years), female sex, reduced eGFR, prolonged extracorporeal circulation time, and left main stem stenosis were independent predictors of mortality.
Conclusions:
- Age remains a significant independent predictor of postoperative complications and mortality following isolated CABG.
- Risk stratification and careful management are essential for elderly patients undergoing CABG.
Introduction:
Coronary artery bypass grafting (CABG) is conducted more and more commonly in patients in advanced age.
Aim Of The Study:
To analyze the influence of age and concurrent risk factors on the complications and early mortality after CABG.
Material And Methods:
Medical records of 2194 patients were analyzed retrospectively. A group of 1303 patients who had undergone isolated CABG was selected. 106 (4.8%) patients were excluded due to missing data in their medical records. The remaining 1197 patients were divided into two subgroups by age: 1(st) group < 65 years (n = 662; 55.3%); 2(nd) group ≥ 65 years (n = 535; 44.7%).
Results:
The total 30-day mortality was 3.93% and was six times higher in the older group (1.21 vs. 7.29%; p < 0.001). Complications were observed in 176 (14.70%) patients, more often in the older group (10.42% vs. 20.0%; p < 0.001). In this group all kinds of complications were noted more often and in particular: postoperative myocardial infarction (1.96% vs. 5.42%; p = 0.001), respiratory dysfunction (1.36% vs. 4.11%; p = 0.005), neurological complications (1.81% vs. 3.74%; p = 0.04) and multi-organ dysfunction syndrome (0.30% vs. 1.68%, p = 0.03). The older patients required longer time under mechanical ventilation (24.0 ± 27.9 vs. 37.0 ± 74.1 hours; p = 0.004) and stayed longer in the intensive care unit: 2.5 ± 3.0 vs. 4.1 ± 7.84 days; p < 0.001. Independent predictors of death were: female sex [OR (95% CI) = 2.4 (1.2-4.5)], age ≥ 65 years [OR = 4.9 (2.1-11.1)], eGFR < 60 mL/min/1.73 m(2) [OR = 2.2 (1.0-4.7)], time at extracorporeal circulation > 72 minutes [OR = 5.5 (2.7-10.9)] and left main stem stenosis (> 50%) [OR = 2.4 (1.3-4.6)].
Conclusions:
Age still significantly influences postoperative complications and mortality after isolated CABG.
