Coronary artery bypass in septuagenarians. Analysis of mortality and morbidity

Elective coronary artery bypass surgery can be performed with an expected operative mortality of 1-3%. However, the effects of age on morbidity and mortality in patients undergoing this procedure remain controversial. To analyze morbidity and mortality in septuagenarians undergoing isolated coronary artery bypass surgery, we compared the results in 685 septuagenarians with those in 3,142 patients under the age of 70 years, all of whom underwent this procedure from January 1981 to December 1986. A larger percentage of elderly patients had triple-vessel disease (89% vs. 71%), left main coronary artery obstruction (34% vs. 16%), and ejection fractions less than 45% (68% vs. 41%). A larger percentage of septuagenarians had perioperative myocardial infarction (8% vs. 2%), required prolonged ventilatory support (10% vs. 3%), and had major neurological complications (4% vs. 1%). Mortality rates were significantly higher in elderly patients (7% vs. 2%) but did not correlate with the severity of coronary artery disease, the anginal pattern, or the diminishment of ventricular function. Major causes of mortality were pulmonary failure, renal failure, or both, sepsis, and neurological complications. These data suggest that elderly patients have an increased risk of cardiac and noncardiac morbidity and mortality after coronary artery bypass surgery. Higher mortality rates in this age group appear attributable to noncardiac organ failure. Late follow-up studies failed to show any significant difference among patients based on age alone.