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Published on: March 27, 2018
Coronary Artery Bypass Grafting in Octogenarians-Risks, Outcomes, and Trends in 1283 Consecutive Patients
Kukbin Choi1, Chaim Locker1, Benish Fatima1
1Department of Cardiovascular Surgery, Rochester, MN.
Insights
Coronary artery bypass grafting (CABG) in patients over 80 shows decreasing operative mortality and improved long-term survival. Despite higher surgical risks, CABG in octogenarians can lead to favorable outcomes and extended life expectancy.
Area of Science:
- Cardiology
- Cardiac Surgery
- Geriatric Medicine
Background:
- Coronary artery bypass grafting (CABG) is a significant intervention for coronary artery disease.
- Patients over 80 years old represent a growing demographic undergoing complex cardiac procedures.
Purpose of the Study:
- To evaluate the risks, outcomes, and survival trends in octogenarians undergoing isolated CABG.
- To identify factors influencing mortality in this elderly patient cohort.
Main Methods:
- Retrospective analysis of 1283 patients aged over 80 who underwent primary isolated CABG between 1993 and 2019.
- Kaplan-Meier survival analysis and logistic regression for temporal trends.
- Multivariable Cox regression to determine mortality risk factors.
Main Results:
- Overall operative mortality was 4% and significantly decreased over the study period.
- Estimated 15-year survival rate was 8.2%, with a median survival of 7.6 years, exceeding matched controls.
- Identified risk factors for mortality included older age, atrial fibrillation, diabetes, smoking, cerebrovascular disease, immunosuppression, renal dysfunction, lung disease, peripheral vascular disease, low ejection fraction, and high STS score.
Conclusions:
- Coronary artery bypass grafting in octogenarians, while carrying inherent risks, is associated with favorable long-term outcomes and survival benefits.
- Further research is needed to pinpoint specific subgroups of octogenarians who would most benefit from surgical revascularization.
Objective:
To describe the risks, outcomes, and trends in patients older than 80 years undergoing coronary artery bypass grafting (CABG).
Methods:
We retrospectively studied 1283 consecutive patients who were older than 80 years and underwent primary isolated CABG from January 1, 1993, to October 31, 2019, in our clinic. Kaplan-Meier survival probability and quartile estimates were used to analyze patients' survival. Logistic regression models were used for analyzing temporal trends in CABG cases and outcomes. A multivariable Cox proportional hazards regression model was developed to study risk factors for mortality.
Results:
Operative mortality was overall 4% (n=51) but showed a significant decrease during the study period (P=.015). Median follow-up was 16.7 (interquartile range, 10.3-21.1) years, and Kaplan-Meier estimated survival rates at 1 year, 5 years, 10 years, and 15 years were 90.2%, 67.9%, 31.1%, and 8.2%, respectively. Median survival time was 7.6 years compared with 6.0 years for age- and sex-matched octogenarians in the general US population (P<.001). Multivariable Cox regression analysis identified older age (P<.001), recent atrial fibrillation or flutter (P<.001), diabetes mellitus (P<.001), smoking history (P=.006), cerebrovascular disease (P=.04), immunosuppressive status (P=.01), extreme levels of creatinine (P<.001), chronic lung disease (P=.02), peripheral vascular disease (P=.02), decreased ejection fraction (P=.03) and increased Society of Thoracic Surgeons predicted risk score (P=.01) as significant risk factors of mortality.
Conclusion:
Although CABG in octogenarians carries a higher surgical risk, it may be associated with favorable outcomes and increase in long-term survival. Further studies are warranted to define subgroups benefiting more from surgical revascularization.
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