Complete Coronary Revascularization Improves Survival in Octogenarians.
Spencer J Melby1, Lindsey L Saint1, Keki Balsara1
1Division of Cardiothoracic Surgery, Department of Surgery, Washington University in St. Louis, St. Louis, Missouri.
The Annals of Thoracic Surgery
|April 23, 2016
Summary
Incomplete revascularization after coronary artery bypass graft surgery in octogenarians is linked to poorer long-term survival. Achieving complete or total revascularization improves outcomes for these elderly patients.
Area of Science:
- Cardiovascular Surgery
- Geriatric Medicine
- Outcomes Research
Background:
- Completeness of revascularization is crucial after coronary artery bypass graft (CABG) surgery.
- Long-term impact of revascularization completeness in octogenarian patients remains understudied.
Purpose of the Study:
- To evaluate the long-term survival impact of different extents of revascularization in octogenarian patients undergoing CABG surgery.
Main Methods:
- A cohort of 525 patients aged 80+ years undergoing CABG between 1986-2004 were followed for at least 10 years.
- Revascularization was categorized as total, complete, or incomplete.
- Survival outcomes were stratified based on the extent of revascularization.
Main Results:
- Operative mortality was 8% overall, with a trend towards higher mortality in incomplete revascularization.
- Mean survival for survivors was significantly improved with total (6.9 years) and complete (6.8 years) revascularization compared to incomplete (5.4 years).
- Ten-year survival rates were 27% for total, 21% for complete, and 16% for incomplete revascularization.
Conclusions:
- Incomplete revascularization in octogenarians is associated with significantly decreased long-term survival.
- No significant survival benefit was observed for total revascularization over complete revascularization.
- Octogenarian patients can achieve good long-term survival with adequate revascularization.
Related Concept Videos
01:27Coronary Artery Disease V: Interprofessional Care
395
Interprofessional care for coronary artery disease includes pharmacological therapy and revascularization procedures.Pharmacological therapy for Coronary Artery Disease (CAD) aims to manage symptoms, prevent complications, and improve patient outcomes through various classes of medications:Antiplatelet Agents:Aspirin and Clopidogrel: These medications inhibit platelet aggregation, preventing blood clots, which is crucial for avoiding heart attacks and strokes. Doctors often prescribe these...
395
01:26Coronary Artery Disease IV: Preventive Measures
837
Effective preventive measures for coronary artery disease (CAD) focus on controlling modifiable risk factors, including cholesterol abnormalities and lifestyle changes.Cholesterol ManagementFirst, the Mediterranean diet and the American Heart Association advocate for maintaining low-density lipoprotein (LDL) cholesterol levels below 100 mg/dL, with a more stringent recommendation of below 70 mg/dL for individuals at high risk. LDL cholesterol, often termed "bad cholesterol," can lead to the...
837
01:28Acute Coronary Syndrome IV: Interprofessional Care
431
IntroductionThe management of Acute Coronary Syndrome (ACS) aims to minimize myocardial damage, preserve myocardial function, and prevent complications.Initial ManagementInpatient management involves continuous cardiac monitoring, preferably in an ICU, focusing on blood pressure, serum sodium, potassium, and creatinine levels, and urine output. Ongoing pharmacologic management is crucial for stabilizing the patient.Supplemental Oxygen: Administer supplemental oxygen if oxygen saturation is...
431
01:30Coronary Artery Disease I: Introduction
1.6K
Coronary Artery Disease (CAD): An Overview with Scientific InsightsCoronary Artery Disease (CAD), often referred to as C-A-D, is a prevalent blood vessel disorder classified under the broader category of atherosclerosis. Atherosclerosis is a pathological process characterized by the hardening and narrowing of arteries due to the accumulation of atherosclerotic plaques. These plaques are composed of cholesterol, fatty substances, inflammatory cells, calcium, and fibrin, reducing blood flow to...
1.6K
01:30Acute Coronary Syndrome III: Diagnostic Studies
409
Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...
409
01:26Coronary Artery Disease II: Pathophysiology
937
Coronary Artery Disease (CAD) originates from a series of events that impair the function of coronary arteries, the blood vessels responsible for delivering oxygen-rich blood to the heart muscle. The pathophysiology of CAD is closely linked to atherosclerosis, a chronic inflammatory and lipid-driven condition affecting the vascular endothelium.1. Endothelial DamageThe process begins with damage to the vascular endothelium, which serves as a protective barrier between the blood and the vessel...
937