Midterm Outcomes for Isolated Coronary Artery Bypass Grafting in Octogenarians

An increase in the life expectancy of the general population has led to heightened numbers of elderly patients in need of coronary artery bypass grafting (CABG). Surgical revascularization in octogenarians is becoming more commonplace, and outcomes in this cohort continue to gain relevance.

All patients who underwent isolated CABG (n = 7048) at the University of Pittsburgh Medical Center from 2010 to 2017 were reviewed. A comparative analysis between octogenarians (≥80 years) and septuagenarians (70-79 years) was performed with primary outcomes that included all-cause mortality and readmission at 30 days, 1 year, and 5 years.

The total patient population consisted of 2226 patients who were divided into two age groups, including 1673 septuagenarians (75.2%) and 553 octogenarians (24.8%). Mean age was 74.19 ± 2.80 years versus 82.94 ± 2.57 years (P < .001) for the first and second cohort, respectively. The octogenarian group had higher operative risk represented by a mean Society of Thoracic Surgeons Predicted Risk of Mortality of 6.03% ± 6.42% (P < .001). Operative mortality was higher in octogenarians (5.24% versus 2.69%; P = .004). Predictors of long-term mortality included chronic lung disease (hazard ratio [HR] = 1.76; 95% confidence interval [CI], 1.43-2.17; P < .001), emergent status (HR = 2.09; 95% CI, 1.34-3.28; P = .001), and peripheral artery disease (HR = 1.61; 95% CI, 1.31-1.97; P < .001). Patients 80 years and older had increased risk of both cardiac readmission (HR = 1.2; 95% CI, 1.03-1.40; P = .02) and heart failure readmission (HR = 1.53; 95% CI, 1.23-1.91; P < .001).

CABG can be performed in octogenarians with acceptable survival although they have an increased risk of readmission for cardiac causes, specifically, higher rates of heart failure.